Reaction paper

Sociology of Health & Illness Vol. 17 No. 5 1995 ISSN 0141-9889 pp. 577-604

Theorising class, health and lifestyles: can Bourdieu help us? Simon J. Williams Department of Sociology, University of Warwick

Abstract What is the relationship between class, health and life-styles, and to what extent does health-related knowledge influence subsequent behaviour? These issues have been a source of considerable debate for medical sociologists and others con- cerned with promoting 'healthier' life-styles over the years. Yet despite a wealth of empirical material, there has been httle attempt to theorise this relationship between class, health and lifestyles and the associated issues of structure and agency, accounts and action it raises. This paper attempts to rectify this lacuna through a critical discussion of the work of Pierre Bourdieu, and its relevance to the class, health and life-styles debate. In particular, attention is paid to Bourdieu's analysis of the logic of practice, his concepts of habitus and bodily hexis, and the search for social distinction in the construction of (health-related) life-styles. The paper concludes with a critical commentary on these issues and the relative merits of Bourdieu's analysis for the sociology of health and illness. It is argued that despite certain limitations regarding issues of agency and 'choice', Bourdieu's analysis does indeed shed important light on the health and lifestyles debate, and that further bridge-building exercises of this nature between main- stream theory and the sociology of health and illness are both necessary and fruitful

Introduction

How are we to explain health-related behaviour? What is the relationship between health-related knowledge and action? And what role do socio- economic factors such as class play? These are issues which have been a source of considerable debate for those who, from a variety of different © Blackwdl Publishers Ltd/Ediional Board 1995. Ptiblishcd by Blackwdl Publishcre. 108 Cowlcy Road Oxford 0 X 4 IJF, UK and 238 Main Streel, Cambridge, MA 02142, USA.

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backgrounds, have been concerned with the promotion of 'healthier' lifestyles. In particular, one of the thorniest problems concerns the relation- ship, or more correctly the lack of one, between health beliefs and health- related behaviour. Thus, while the lay populace appears, to a large extent, to have assimilated the health promotion messages with which they are con- stantly bombarded (Blaxter 1990) - even those in the poorest socio-eco- nomic circumstances (Blaxter 1993) - the translation of this message into actual practice remains a fundamental stumbling block for those concemed with the promotion of 'positive' change to a 'healthier' lifestyle. In this respect, while it is possible to point to some encouraging trends such as the reduction in smoking, alcohol consumption, the wearing of car safety belts and the use of contraception - factors which, at least in part, may be attrib- utable to public health campaigns - the social patterning of lifestyles and behavioural change, together with the continuing evidence of widespread 'health risking' forms of behaviour, points to the magnitude of the prob- lems still to be faced.

Meanwhile, evidence continues to grow concerning the link between class and health and the fact that poorer people have shorter, more illness-ridden lives than their more affluent counterparts (Townsend et al. 1988, Davey Smith et al. 1990, Davey Smith and Morris 1994). In this respect, the rela- tive importance of health related behaviour and lifestyles vis-d-vis the wider socio-economic determinants of health has been a source of considerable debate. Yet, as various studies have shown, this issue is further complicated by the fact that the strength of association between different types of health-related behaviour is at best only modest (Pill and Stott 1982, 1985, Blaxter 1990). For example, in the recent health and lifestyles survey, Biaxter (1990) shows that extremes of totally 'healthy' or 'unhealthy' behav- iour are rare. Rather, mixed pattems are the norm. In short, the inference to be drawn from such studies is that health-related behaviour is not unidi- mensional, rather it is a complex, multi-dimensional, phenomena.

Broadly speaking, approaches to this issue tend to bifurcate into those which, traditionally, have tended to focus on the significance of health beliefs in explaining pattems of health-related behaviour, and those which concentrate on the relationship between health-related behaviour and broader socio-economic circumstances. For example, conceming the former approach, a number of models have been proposed which suggest that health-beliefs may be important determinants of health-related behaviour. In this respect, the health belief model (HBM) (Janz and Becker 1984), and the (multi-dimensional) health locus of control (Wallston et al. 1978) have probably received most attention. Yet, as empirical evidence suggests, the health belief dimensions identified in both the health belief model and the health locus of control, have only limited explanatory value. Moreover, in addition to these weaknesses at the empirical level, there are also problems at the conceptual level (Langlie 1979, Calnan and Rutter 1986, Calnan 1989, Calnan 1994). © Blackwell Publisher Ltd/Editorial Board IW5

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In contrast, other more sociological studies have shown how people's general beliefs about health, and the degree to which they feel they have control over their daily lives, are shaped by their position within the broader social structure (Illsley 1980). For example, Blaxter and Patterson (1982) have shown how 'low' norms regarding health are adopted by those living in p)oor socio-economic circumstances due to the relatively greater experience of illness suffered by this group. Such definitions of health, it is claimed, are likely to be antithetical to the adoption of so-called 'health related-behaviours'. Similarly, Comwell (1984), in her ethnographic study of working-class people living in the East-End of London, shows how peoples' living and working conditions shape their beliefs about health and illness. Thus, whilst being healthy depended upon whether or not one was 'naturally endowed' with a good constitution, good health was also earned through leading a life of 'mod- eration', virtue' and 'hard work'. In addition, studies of food and health beliefs have also shown interesting differences according to social class. For example, in a comparison of working-class and middle-class women, Calnan (1990) showed that in contrast to middle-class women's emphasis upon a 'balanced diet' and 'everything in moderation', the working-class women were more concerned about meals being 'substantial' and 'filling'.

There have also been attempts to identify the circumstances in which behavioural change occurs. For example, using a qualitative methodol- ogy. Hunt and Macleod (1987) examined what makes people change their behaviour. Here they found little evidence to suggest that changes in health-related behaviour were a response to formal messages. Rather, most change occurred only after a prolonged period of thought, often of an intermittent nature, and there tended to be sporadic attempts at change before a successful outcome was finally achieved. Interestingly, whilst the reasons given for change were varied, health was cited infre- quently. Instead, they included financial factors for smoking and diet, change of social scene for smoking, diet, exercise and drinking, family problems and self-esteem for tranquillisers, and vanity and clothing prob- lems for diet. In addition this study also highlighted the close inter- relationship between different forms of behaviour. For example, respon- dents said that they engaged in exercise in order to ofT-set the effects of alcohol and smoking, and the link between smoking and weight control was frequently alluded to.

Other studies, in contrast, have more directly addressed the role which socio-economic factors and material circumstances play in shaping health- related behaviours and their meaning in the context of people's daily lives. This approach is well illustrated in the work of Graham (1984, 1987, 1989, 1993), who shows that whilst mothers are well aware of the health links associated with activities such as cigarette smoking, they pro- vide a means of 'coping' with the stresses and strains of their daily lives and maintaining some, albeit precarious, sense of 'equilibrium'. In such

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circumstances, the sociai benefits oi smoking were seen to outweigh the known costs, and behavioural change proved difficult when viewed within the context of these women's daily lives. Similarly, Gabe and Thorogood (1986) show how patterns of smoking and tranquilliser use amongst black and working-class women relate to their varying degrees of access to other resources such as paid work, social support, leisure, and religion. In addition, there have also been attempts to highlight the role of material factors and the internal structure of the family in shaping and constrain- ing patterns of food choice and consumption (Charles and Kerr 1986, Calnan and Cant 1990), and the differential meanings of exerdse accord- ing to social class (Calnan and Williams 1992).

At a broader level, Blaxter (1990), in her analysis of the Health and Lifestyle Survey (HALS) has attempted to estimate the relative effects of circumstances and attitudes on behaviour. WhUst there was some evi- dence to suggest that attitudes did exert an effect on behaviour {i.e. people with positive attitudes or beliefs that behaviour was important were more likely to adopt 'healthy' lifestyles), when sodal class and income were controlled their influence largely disappeared. The study has also drawn attention to the differential impact of b«havioural change for health status according to sodo-economic position. In this respect, whilst stopping smoking may considerably improve health status for those of higher socio-economic status, its impact is considerably less for members of lower socio-economic groups (Blaxter 1990). More recently, in a sub- sequent follow-up study seven years on from the previous HALS (Cox et al. 1993), it was found that whilst, at an aggregate level, attitudes and lifestyles had remained fairly stable across the seven year jjeriod, they appeared to be in a considerable state of flux at the individual level.

To summarise, whilst there appears to be a logical connection between concepts of health, beliefs about health maintenance, and health-related forms of behaviour, empirical evidence suggests that their importance may in fact have been overestimated, and that the relationship between knowledge and action is a problematic one (Blaxter 1990, Calnan and Williams 1992, Calnan 1994). Consequently, there has been a gradual shift away from explaining health-related behaviour simply in terms of 'health beliefs' (i.e. health belief models etc.) towards attempting to understand the lay person's actions in terms of their own logic, knowl- edge and beliefs which are grounded in the context of people's daily lives. As a result, recent sociological research has begun to concentrate upon the meaning placed upon the behaviour itself and on how the social cir- cumstances in which people live and work shape their 'style' of life. In this respect, research is beginning to unravel the complex inter-play between social structure, beJiefs about behaviour and its meaning, and pattems of health-related behaviour (Calnan 1994).

Yet despite these important shifts of focus, a great deal of research still needs to be done concerning how and why people adopt, maintain and O Bkicicwc)] P u b l i s h e r Ltd/EditoriaS Board )d95

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change their lifestyles. Indeed, beyond the level of further empirical elab- oration, there remains an urgent need to understand and explain these issues at a theoretical level. In particular, the issues which this debate throws up relate very closely to some of the core problems of sociological theory concerning the relationship between structure and agency, beliefs and behaviour, and accounts and action. A key question in this respect concerns how, exactly, we are to theorise the structure-agency problem in relation to health-related behaviour? To date, little attention has been paid to this question within medical sociology, and yet it is clearly central to the debate over health and lifestyles. This in turn, of course, relates, at a more general level, to the commonly voiced criticism of medical sociol- ogy; namely, that it is a largely a-theoretical, applied sub-disciphne in the service of medicine. Clearly, as recent work shows (Scambler 1987, Gerhardt 1989), such a contention is incorrect, yet the fact still remains that the link between health and lifestyles needs to be far more ade- quately theorised, and that further links between medical sociology and mainstream theory could profitably be made.

Hence, it is in an attempt to rectify this lacuna and to offer a theoreti- cal acxount of the relationship between class, health and lifestyles, draw- ing upon the work of Pierre Bourdieu, that this paper is devoted. In this respect, as I hope to able to show, despite its limitations, Bourdieu's work does indeed have much to offer in terms of the health and lifestyles debate. Moreover, the manner in which he manages to weave together both empirical data and theoretical insight is a lesson to us all in the art of 'doing' sociological research. It should also perhaps be stressed at this point that, as the title suggests, the primary focus of this paper is on the- orising the relationship between class, health and lifestyles, rather than other aspects of social structure such as gender, age or ethnicity. Whilst these other elements of social structure are equally important in the health and lifestyles debate, an adequate discussion of them is clearly beyond the scope of a single paper. Thus, without further ado, let us 'dive into' Bourdieu's work. In order to do so, it is essential to spend some time explaining the key concepts of his theory so as fully to grasp its significance for the class, health and lifestyles debate. We start, there- fore, with a discussion of the 'logic of practice'.

Practical logic and the logic of practice

As Jenkins (1992) observes, whilst Bourdieu's focus upon the visible world of social practice is not particularly original, the importance of his project lies in the attempt to construct a theoretical model of social prac- tice, and to do so without losing sight of the wider structures and pat- terns of social life. In particular, his analysis of practice is characterised by a number of key features which contain important implications for the

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analysis of health-related behaviour and lifestyles more generally. Let us look at each of these in turn.

First, Bourdieu stresses the obvious fact that practice is heated in time and space. That is to say, pra<^ce involves movement in space and move- ment in space, of necessity, involves movement in time (Jenkins 1992). Secondly, and perhaps more importantly for this paper, Bourdieu stresses the fact that practice is not conscioitsly. or at least not wholly consciously organised. Whilst not purely arbitrary, practice nonetheless 'happens' in the sense that it possesses a practical logic - something Bourdieu likens to a 'feel for the game', which works 'outside consdous control and discourse' (Bourdieu 1990: 61). That is to say, most of us, most of the time, take our- selves and the social world around us for granted; we do not think about what we do because, quite simply, we do not have to. Ind^d, the business of sodal life would be impossible if it were not taken for granted most of the time: imagine the absurdity of having to keep an active file in our heads of each and every social rule and regulation! (Jenkins 1992). As Bourdieu epigrammatically puts it: 'Each agent, wittingly or unwittingly, willy nilly, is a producer and reproducer of objective meaning . . . it is because subjects do not, strictly speaking, know what they are doing that what they do has more meaning than they know' (1977: 79).

It is through this stress on the logic of practice that Bourdieu attempts to capture the 'intentionality without intention', the 'knowledge without cognitive intent', that 'pre-reflective, infraconscious mastery' which agents acquire in their social world by virtue of their 'durable immersion' within it (Bourdieu and Wacquant 1992: 19). Elsewhere, Bourdieu refers to this taken-for-granted feature of social practice as 'doxic experience': namely that 'coincidence of objective structures and internalised structures' (Bourdieu 1990: 20). In this respect, Bourdieu shares a similar position to that of Giddens (1984) who also emphasises the fact that much of daily life is accomplished unthinkingly and routinely, through what he terms 'practical consciousness'. Yet as Bourdieu also points out, sodal life, in all its richness and complexity, is not simply accomplished on a rule- govemed basis. Rather, practice has an essentially improvisory nature and a 'fuzzy logic'. As such, lines of action engaged in according to the logic of practice, do not, indeed cannot, have the neat and tidy regularity of con- duct deduced from normative or juridical principles (Wacquant 1992: 22).

Building on this point, the third feature of Bourdieu's account of prac- tice concems the fact that whilst it is organised in a manner largely devoid of conscious deliberation or reflexive control, it is not without its purpose or practical intent. Here the aim is not only to emphasise the fact that individuals do have goals and interests, but also to locate the source of their practice in their own experience of reality {i.e. their practi- cal logic), rather than the second-order analytical models which sodal sci- entists construct in order to predict and explain that practice (e.g. Rational Action Theory or RAT for short! (Jenkins 1992). As Jenkins O Blackwell Publishers Ltd/Editorial Board 1995

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(1992) observes, this is summed up in Bourdieu's description of his theo- retical move from 'rules to strategies'. His use of the notion of 'strategies' is, however, quite different from that of recent sociological debates con- cerning this concq>t, as it is meant to capture that subtle inter-play of freedom and constraint which characterises social interaction, and enables individuals to 'know without knowing' the right thing to do (Jenkins 1992). In Bourdieu's hands therefore, the notion of 'strategy' is not quite as fluid and open as it might first appear.

In applying these arguments to the field of health, some important issues already begin to emerge. In particular, it is possible to argue that much of what we commonly and unthinkingly refer to as 'health-related behaviour' - itself an analytical or second-order construct - is in fact, when viewed in the context of actors' daily lives, part and parcel of a practical rather than an abstract logic. In other words, 'health-related behaviour' is itself a routinised feature of everyday life; something which is woven into its very fabric. As such, its connection with matters con- cerning health remains an open question. In short, health-related behav- iour can be seen as a largely routinised feature of everyday life which is guided by a practical or implicit logic.

Further support for this contention comes from a recent ethnographic study by Calnan and Williams (1992), which attempted to identify how salient health was within people's daily lives and the meaning of health- related behaviour in this context. The evidence showed that, irrespective of socio-economic circumstances, matters of health rarely surfaced spon- taneously in people's descriptions of their daily lives, nor did a concern with health in the context of behaviour. Instead, it was only at the level of probed discourse or in the context of illness that discussions about health matters and their relationship to life-styles seemed to emerge. In other words, health tended to be largely taken for granted and was only spoken about in its absence, whilst aspects of what we term 'health- related-behaviour' were in reality routinised features of daily life which merited no comment unless problems 'loomed large'. These issues, in turn, echo Young's (1981) earlier distinction between what he terms 'rep- resentational knowledge' (i.e. 'knowledge of something') and 'practical knowledge' (i.e. knowledge produced in response to something').

In addition, Bourdieu's emphasis upon practical logic and the logic of practice has important implications for the conduct of sociological research. Indeed, as Bourdieu argues, a research strategy which is designed to elicit informants' accounts and explanations of their behav- iour (practice) is not only misplaced but liable to (re)produce a mislead- ing picture. As we have seen, the nature of practical logic implies that a good deal of actors' behaviour is accomplished unthinkingly and unknowingly: much of social life is simply taken for granted and its logic is implicit. It is, therefore, Bourdieu argues, literally asking too much of infonnants to explain the principles which structure their actions. Rather,

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what one gets is simply 'official accounts' or discourses about practice in which informants tend to describe what ought to happen because the social nature of the research situation encourages them to Justify rather than describe their behaviour. In other words, informants move from what Giddens (1984) terms 'practical consciousness', to a form of 'discur- sive consciousness'; the relationship between the two being far from clear- cut. One thinks here too, in a similar vein, of Comwell's (1984) familiar distinction between 'public' and 'private' accounts of health and illness.

In particular, Bourdieu points to three main things which are wrong with informants' accounts. Invited by the researcher's questions to effect a reflexive, quasi-theoretical retum to their own practice, informants are liable to produce 'a discourse which compounds two opposing systems of lacunae' (1977: 18). First, in so far as it is a 'discourse of familiarity', it takes much of what is important for granted, and 'leaves unsaid all that goes without saying'. As a consequence many of the tacit features of social life are passed by in silence and remain unspoken. Secondly, in so far as it is an ^outsider-oriented-discourse', in which informants assume the questioner's unfamiliarity, these accounts tend to be couched at levels of generality which exclude all direct reference to particular situations and cases. Finally, and perhaps most seriously of all, the informant's dis- course owes its best-hidden properties to the fact that it is the product of a semi-theoretical disposition, inevitably induced by any learned question- ing. Here the rationalisations produced, which are no longer those of practical logic, meet with and confirm the expectations of 'formalism' to which the situation inclines the observer. In this respect, the informant's discourse and the desire to impress, tends to draw attention to the 'most remarkable "moves'". Perhaps the subtlest pitfall of all, however, stems from the fact that such discourses draw freely upon and make constant recourse to a vocabularly of 'rules' in order to describe what is, in reality, the product of tacit, unreflective, practical knowledge. As Bourdieu him- self puts it in characteristically elliptical style:

The explanation agents may provide of their own practice, conceals, even from their own eyes, the true nature of their practical mastery, i.e. that it is learned ignorance (docta ignorantia), a mode of practical knowledge not comprising knowledge of its own principles. It follows that this leamed ignorance can only give rise to the misleading discourse of a speaker himself {sic) misguided, ignorant both of the objective truth about his (jic)-practical mastery (which is that it is ignorant of its own truth) and of the true principle of the knowledge his practical mastery contains (1977: 19).

To invite people, therefore, in an interview context, to account for and explain their (health-related) behaviour is, at best, problematic, and at worst, misguided. O Blackwell Publishers Ltd/Editorial Board 1995

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To summarise the argument so far, according to Bourdieu, much of daily life (including health-related behaviour) is simply taken for granted and organised according to a practical, largely unthinking, logic of which actors are only dimly aware. As a consequence, research subjects are not nec«sarily able to account for their actions in anything other than 'official', rule-governed terms which, of necessity, omit reference to its practical logic. Herein lies the significance of all that remains implicit and unspoken in daily life for, as we have seen, 'what actors do has more meaning than they know'. It is at this point that Bourdieu's concept of habitus plays a crucial explanatory and mediatory' role not only in accounting for the logic, durability and unthinking nature of practice, but also in terms of straddling the divide between structure and agency. Hence it is to an explication and discussion of this and other related con- cepts such as field and capital that we now turn.

Habitus, field and capital

Central to Bourdieu's attempt to transcend the sterile dualism of objec- tivism and subjectivism is his concept of the habitus. In placing primary emphasis upon practice and its logic, (i.e. what individuals do in their daily lives), Bourdieu rejects the suggestion that this can simply be explained in terms of individual decision-making, or supra-individual determinative social structures operating behind the backs of social actors. In this respect, his concept of the habitus can be seen as an attempt to bridge the gap between these two extremes and to interdigitate structure and agency. For Bourdieu, the habitus may be conceptualised as an 'acquired system of generative dispositions', which is objectively adjusted to the particular conditions in which it is constituted (1977: 95). It is through the habitus that:

. . the structure which has produced it governs practice, not by the processes of a mechanical determinism, but through the mediation of the orientations and limits it assigns to the habitus's operations in invention. As an acquired system of generative schemes objectively adjusted to the particular conditions in which it is constituted, the habitus engenders all the thoughts, all the perceptions, and all the actions consistent with those conditions, and no others (1977: 95). In other words, the habitus, whose limits are set by the historically and

socially situated conditions of its production, is a 'structuring structure', a 'socialised subjectivity' which gives rise to and serves as the classificatory basis for individual and collective practices. It is formed in the context of people's social locations and inculcates them into a 'world view' which is based upon and reconciled to their position, thus serving to reproduce existing social structures. As such, the habitus provides individuals with

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class-dependent, pre-disposed, yet seemingly 'naturalised' ways of think- ing, feeling, acting and classifying the sodal world and their location within it.

Moreover, as Bourdieu points out, these dispositions and generative schemes of classification are literally and metaphorically embodied in human beings. Indeed, for Bourdieu, the very ways in which people treat and relate to their bodies reveal 'the deepest dispositions of the habitus' (1984: 190). As Jenkins (1992) points out, this is so for three main rea- sons. First, the habitus is embodied in the simple, straightforward sense that it is located 'inside' actors' heads: or what Bourdieu, in a characteris- tically tortuous phrase refers to as the 'intemalisation of exteriority and extemalisation of interiority'. Secondly, the habitus only exists in and through the concrete practices of individual, embodied agents, situated in time and space, and their interactions with others and their environment. In this sense, habitus, as a concept is definitely not simply an abstract concept. Thirdly, what Bourdieu refers to as the 'practical taxonomies' which structure our perceptions and classification of the social world {e.g. male/female, inside/outside, front/back, high/low, hot/cold) are also rooted in and only make sense from the point of view of the body (Jenkins 1992: 74-5). On this issue, Bourdieu shares a similar position to that of Merleau-Ponty (1962), who emphasises that perception is grounded in the body.

This emphasis upon the embodiment of the habitus is further under- lined by Bourdieu's notion of 'bodily hexis'. Bodily hexis, relates directly to forms of body posture, deportment, style and gait. In other words, bodily hexis concems the socially inscribed manner in which individuals 'carry themselves' (Bourdieu 1984: 218). As Bourdieu puts it, bodily hexis is:

. . . political mythology realized, em~bodied, tumed into pemianent dispositions, a durable manner of standing, speaking, and thereby of feeling and thinking . . . The principles em-bodied in this way are placed beyond the grasp of consciousness, and hence cannot be touched by voluntary, deliberate transfonnation, cannot even be made explidt(l977: 94). In keeping with Bourdieu's emphasis upon the logic of practice, the

power of the habitus and bodily hexis derives, therefore, from the largely thoughtless nature of practice and habit, rather than from consciously teamed rules and principles (Jenkins 1992: 76). In this sense, whilst the habitus is meant to function as an 'opren system of dispositions', there is a 'relative irreversibility' to the process (Bourdieu and Wacquant 1992: 133): the habitus is the 'unchosen principle of all choices', which in turn is largely determined by the social and economic conditions of its consti- tution (Bourdieu and Wacquant 1992: 136).

At this point, it is necessary to introduce two other concepts which also O Blackwell Publishers Ltd/Editorial Board I99S

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play a crucial role in Bourdieu's work; namely, field and capital. As Bourdieu makes clear, society cannot be conceptualised as a homoge- neous whole. Rather, it is composed of a network of relatively autonomous 'fields' which operate according to their own internal logics and dynamics. In this respect, fields are defined according to the particu- lar stakes at issue {e.g. cultural goods (lifestyle), intellectual distinction (education), power (politics) etc.), each with its own internal logic and taken-for-granted structure which is both the product and producer of the specific habitus appropriate to it:

In analytic terms, a field may be defined as a network, or a configura- tion, of objective relations between positions. These positions are objectively defined, in their existence and in the determinations they impose upon their occupants, agents or institutions, by their present and potential situation in the structure of the distribution of species of power (or capital) whose possession commands access to the specific profits that are at stake in the field, as well as by their objective relations to other positions (domination, subordination, homology etc.) (Bourdieu and Wacquant 1992: 94).

A field, therefore, is a structured system of social positions. It is also a structured system of force or power relations in the sense that positions occupied within the field stand in relations of domination, subordination, homology to one another by virtue of the access they afford or deny to the goods or resources {i.e. capital) which are at stake. In this respect, Bourdieu usefully divides these resources or forms of capital into four main categories: namely, economic capital, cultural capital (legitimate knowledge of various sorts), social capital (involving various kinds of relations with significant social others) and symbolic capital (prestige and social honour). In addition, the body, for Bourdieu, is also a form of cap- ital, which is sometimes specifically referred to as 'physical capital' (Bourdieu 1978: 832) and at other times subsumed under the more gen- eral rubric of 'cultural capital' As with the habitus, Bourdieu points out that capital does not exist or function except in relation to a field (Bourdieu and Wacquant 1992: 101). However, as we shall see, as a space of potential and active forces, a field is also, by definition, a 'field of struggles aimed at preserving or transforming the configuration of these forces' (Bourdieu and Wacquant 1992: 101).

To summarise, the habitus of agents, together with the trajectories and strategies which are produced, are operative within tlie context of the opportunities and constraints afforded by the structure of the field itself: a dynamic structure which is characterised by the struggles of agents con- cerned with maintaining or improving their position (comprising the vol- ume and composition of capital) with respect to the particular, form of capital at stake. As Wacquant (1992) points out, it is through the use of concepts such as habitus and field that Bourdieu is able to forsake the

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false problems of 'personal spontaneity and social constraint', 'freedom and necessity", 'choice and obUgation\ and to side-step the common alter- natives of individual and structure', 'micro and macro-analysis' which force a polarised, 'dualistic social ontology' (1992: 23).

Yet, as we shall see, these supposed 'resolutions' may, in fact, be more apparent than real, and there remain a number of problems which haunt Bourdieu's analysis. The root of the problem here is that ultimately Bourdieu remains trapped within an objectivist point of view which largely strips agency of its critical reflexive character. This can be summed up in the simple observation that habitus appears largely to operate behind the backs of actors (Jenkins 1992). The true explanation for actors' behaviour is seen to reside in the mysterious, murky depths of the habitus and, as a consequence, 'choice' is largely underplayed. The result it could be claimed, to borrow Dennis Wrong's (1980) famous phrase, is a classically 'over-socialised conception of man (sic)'. Ultimately then, despite all the references to improvisation, fluidity and strategising, Bourdieu's model turns out to be one of (mindless) confor- mity (Jenkins 1992). In short, actors do and must know more about the social world than Bourdieu is prepared to allow, and, as a consequence, the role in social life of conscious, deliberative decision-making is grossly underestimated- As Jenkins succinctly puts it, Bourdieu's world is one where; 'behaviour has its causes, but actors are not allowed their reasons' (1992: 97). Despite these criticisms, however, as I hope to show, Bourdieu's analysis does still have merit on a number of counts. In par- ticular, in emphasising the broader structural determinants and con- straints on 'choice', Bourdieu's analysis serves as a necessary corrective to other more recent perspectives which, instead, emphasise the increasingly fluid, indeterminate and dynamic nature of lifestyle (re)construction as a consequence of the growth in social reflexivity (Giddens 1991). Moreover, as we shall see, although bounded in certain ways, 'choice' is not in fact ruled out in Bourdieu's analysis.

Having discussed some of Bourdieu's key concepts and their limita- tions, we are now in a position to look more closely at how they 'mesh together' in his analysis of the relationship between the body, class and lifestyles, and at their implications for health.

The body, class and lifestyles: health and the search for distinction

The nature of contemporary struggles and conflict between various classes and class fractions is of great importance in Bourdieu's work. This is most clearly evident in his book (1984) Distinction: A Social Critique of ihe Judgement of Taste - which contains a mass of empirical data and a wealth of theoretical insight (Bourdieu has always been concerned to marry the two). Here, the dominant classes' attempts to define lower-class © Blackwell Publishers Lid/Editorial Board 1995

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bodies and lifestyles as 'crude' and 'vulgar' and working-class attempts to define upper-class activities as 'pretentious', form the central focus of Bourdieu's inquiry in his attempt to map out the social 'space of life- styles' (Shilling 1993). These struggles are wide-ranging and include the attempts of differing social groups to define and appropriate as 'their own' exclusive property, particular styles of dress, sports and many other forms of cultural consumption. Indeed, as Bourdieu suggests, there are as many stylistic possibilities (i.e. stylisations of life for purposes of social distinction), as there are social practices and fields within society. In terms of cultural consumption, the main opposition is between practices defined by their rarity as 'distinguished' by those fractions richest in eco- nomic and cultural capital, and those practices defined as 'vulgar' because they are both 'easy' and 'common' (i.e. those of the fractions poorest in these forms of capital). In between, are those practices which are per- ceived to be 'pretentious' because they manifest an evident discrepancy between the ambition and possibilities of the dominant class (Jenkins 1992).

As Shilling (1993) notes, the stakes in these struggles are high, con- cerned as they are with the differing abilities of social groups to adopt and define the most prestigious bodily forms and practices. The struggle, however, is not a fair or stable one, involving as it does participants with differential resources (i.e. volumes and compositions of 'capital') in a 'game' - this is one of Bourdieu's favourite metaphors in describing the nature and dynamics of social fields - in which the rules are neither explicit, fair, nor unchanging. Because of their greater access to and pos- session of capital, the dominant classes are more likely to be in control of those fields which are invested with the power of bestowing value upon particular bodily forms and lifestyles. Indeed, central to the process involved in the search for social distinction is the ability of dominant groups to define their bodies and their lifestyles as 'superior', 'worthy of respect', and as, both literally and metaphorically, the embodiment of class (Shilling 1993). Here Bourdieu argues that the bodily forms of the working classes constitute a form of physical capital which, operative within the social fields that together make up society, has less 'exchange value' than that developed by the dominant classes. As Shilling (1993) points out, this does not, of course, mean that the working classes com- pletely lack the opportunities to convert their physical capital into other resources. For example, one thinks here of the traming of the body for work or sporting careers, and its 'exchange value' in* programmes like 'Gladiators' or 'Blind Date'. Nonetheless, as Shilling (1993: 137) points out, this form of physical capital is hmiting to the working classes in sev- eral important respects, including the degree to which it can be converted into other valued forms of social and cultural capital. In this sense, mus- cular bodies tend to be 'devalued' in the eyes of the dominant classes as 'vulgar'. Moreover, fields are structured in ways which provide only limited

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opportunities for the bestowing of 'vaiue' {Le. social and cultural legiti- macy) upon working class bodies (ShiUing 1993). In short, for Bourdieu, the search for social distinction involves regular struggles over the definition and control of bodies and practices within the differing fields which together constitute the social space of lifestyles.

In keeping with Bourdieu's general theoretical stance, lifestyles are seen as the product of the habitus, which, he argues, is expressed in and through 'taste'. Indeed, 'taste' is a key issue in Bourdieu's analysis of dis- tinction as it refers to the process whereby individuals adopt as $eemin^y voluntary choices and preferences, lifestyles which are rooted in the habi- tus - what he elsewhere refers to as 'necessity internalised and converted into dispositions' (Bourdieu 1984: 170) - and material constraints. In other words, people develop a taste for 'what is available to them'. It is, as Bourdieu puts it, a '. . . virtue made out of necessity which continu- ously transforms necessity into virtue by inducing 'choices' which corre- spond to the condition of which it is a product' (1984: 175). Domination, therefore, is mediated by taste in Bourdieu's schema. In this sense, to be dominant is to be able to define what a society values as distinction which, in turn, corresponds to what the dominant classes possess and dis- play; thus reproducing their own dominance as 'legitimised distinction' (Frank 1991). Classes reproduce themselves by their intemalisation and display of certain tastes, only some of which are valued as marks of dis- tinction. 'Taste', therefore, is the '. . . practical operator of the transmuta- tion of things into distinct and distinctive signs, of continuous distributions into discontinuous oppositions; it raises the differences inscribed in the physical order of bodies to the symbolic order of significant distinctions' (Bourdieu 1984: 175).

Having reached this point, we are now in a position to summarise Bourdieu's underlying model of lifestyles and social reproduction in the following way. Objective conditions of existence combine with position in social structure to produce the habitus (i.e. an embodied, structured and structuring structure), which generates classifiable practices and serves as the basis of schemes of perception and appreciation or 'taste'. These 'tastes', in turn, form the basis of (class-related) lifestyles of classified and classifying social practices, which, as a consequence, function symboli- cally as signs of social position, status and distinction (Jenkins 1992: MJ-I42). The upshot of this is that the 'systematicity' of lifestyles is ulti- mately reducible to the

. . . synthetic unity of the habitus, the unifying, generative principle of all practices. Taste, the propensity and capacity to appropriate (materi- ally and symbolically) a given class of classified, classifying objects or practices, is the generative formula of lifestyle, a unitary set of distinc- tive preferences which express the same expressive intention in the specific logic of each of the symbolic sub-spaces, furniture, clothing,

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language or bodily hexis. Each dimension of life-style 'symbolizes with' the others . . . and symbolizes them (1984: 173).

The inter-relationship between sodal location, habitus and taste, there- fore, tends to produce relatively stable bodily orientations and lifestyles (including one might add attitudes and orientations towards health). As Shilling notes: 'It is not simply that the lifestyles of women and men from different social classes become inscribed within their bodies, but that these bodies "fit" people for different activities. Whilst change is not ruled out, for Bourdieu there is usually a close match between "social positions and human dispositions"' (1993: 135). Social differences there- fore are 'naturalised', and it becomes more or less second nature for peo- ple to engage in different forms of activity and 'choose' different lifestyles which themselves are accorded differential social and symbolic value in the struggle for distinction (Shilling 1993). Thus we come to see that Ihe body, which is now the body of the habitus, reflects its class position. In other words, it is through the habitus that classes develop clearly identifiable relations with their bodies which result in the production of distinctive bodily forms and are accorded differential economic, social and cultural value (Shilling 1993). Indeed, as the concept of 'bodily hexis' implies, taste is literally embodied, being inscribed onto the body and manifest in its size, volume, demeanour, ways of eating and drinking, walking, spitting, speaking, manners, gestures and so on (Featherstone 1987a, Frank 1991). As Frank observes, the Bourdieuian body is; 'associ- ated in its self-consciousness, predictable in its tastes, producing in its capitals, and monadic in its demonstrative value' (1991: 68).

At a more generai level, it is clear that the sign-bearing, sign-wearing body in contemporary society and consumer culture has increasingly become a source of symbolic value and is closely related to self-identity (Featherstone 1991, Giddens 1991). Here the 'inner concern' with health and the optimum functioning of the body, combines with the 'outer con- cern' with appearance and the movement and control of the body in social space (Featherstone 1991). In this respect, as Featherstone (1991) notes, the vast range of dietary, slimming, exercise and body-maintenance products which are currently produced, marketed and sold, highlight the significance of appearance and bodily preservation within late capitalist society. The result is a 'commodified', 'consuming' body in which the mouth becomes, both literally and metaphorically, the medium and expression of consumption (Falk 1994).

Returning to the critical points raised earlier, it is clear that whilst, for Bourdieu, 'change' is not ruled out, it nonetheless becomes a problematic concept. According to Bourdieu, whilst individuals may indeed change or modify their lifestyles, they will not necessarily be disposed to do so. Moreover, to the extent that change does occur, it tends to be in accor- dance with (i.e. does not contradict) the habitus and underlying body

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schemas of the individual. In other words, whUst change is indeed possi- ble, it largely tends to occur within rather than outside the compass of the habitus. In this respect, although a working-class person may attempt to develop their body along middle-class lines, she or he will not neces- sarily be disposed to do so. Indeed, as Frank (1991) points out, even the dispositions for mobility may be a matter of habitus. As such, Bourdieu's work is open to the charge that it stresses the constraints upon lifestyle 'choices' and the pressures toward uniformity in social class patterns of consumption, at the expense of their fluidity and dynamism. This may, however, be a strength rather than a weakness, serving as a necessary corrective to the view that lifestyles are simply a matter of personal choice in what has become an increasingly reflexive society premised upon 'anomic' forms of consimiption (Warde 1994). The dangers of 'victim-blaming' with this latter type of explanation are all too obvious. Moreover, as we shall see, besides the fact that change is not ruled out in Bourdieu's analysis, he also points to the differential meaning and func- tion of similar social practices engaged in by the various social classes and class fractions in contemporary society. In other words, whilst differ- ent social classes may adopt similar social practices, their meaning and function is likely to be very different.

In seeking to develop these issues further, it may be useful to illustrate them through particular examples of direct relevance to health. In this respect, perhaps the first and most obvious area of application concerns the fact that these differing social class orientations towards the body are evident in lay concepts of health and illness (Blaxter and Patterson 1982, Blaxter 1983, Crawford 1984, d'Houtaud and Field 1984, Pill and Stott 1985, 1992, Calnan 1987, Blaxter 1990, Stainton-Rogers 1991, Saltonstall 1993), Thus in d'Houtaud and Field's (1984) study of a French popula- tion's views of health, for instance, it was found that, for members of the privileged classes, health is appropriated by the individual and employed in a hedonistic way through the expressive use of the body (i.e. seen in abstract terms), whereas the health of working-class people, in contrast, is utilised for the benefit of society (i.e. seen in instrumental terms), which imposes its demands upon bodies required to be 'fit for work'. Similarly, Stainton-Rogers (1991) has identified the common metaphor of the 'body as machine' in working-class men and women's concepts of health and ill- ness, whilst Calnan (1987) has pointed to the greater sense of control which middle-class people feel they have over their health and life-styles. Finally, Pill and Stott (1985) have also implicitly addressed the issue of 'distinction' between home owners and tenants in their study the concepts of illness causation and responsibility of working class mothers. In this respect, the importance and utility of Bourdieu's analysis lies in helping us to account, at a theoretical level, for these findings through concepts such as the habitus, bodily hexis and social and cultural capital: issues which have also been usefully developed by Radley (Radley and Green O Blackwdl Publishers Ltd/Editorial Board 1995

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1987, Radley 1989) in relation to 'styles of adjustment' in chronic illness. Secondly, in the area of food consumption, itself a crucial aspect of the health and life-styles debate, Bourdieu shows how tastes very much depend upon the idea which each class has, through its habitus, of the body, the effects of food on the body in terms of health, strength and beauty, and the categories it uses in order to evaluate these effects (some of which may be important for one class, yet are ignored by another, or ranked very differently):

. , . whereas the working-classes are more attentive to the strength of the physical (male) body than its shape, and tend to go for products that are both cheap and nutritious, the professions prefer products that are tasty, health-giving, light and not fattening. Taste, a class culture turned into nature, that is embodied, helps to shape the class body. It is an incorporated principle of classification which governs all forms of incorporation, choosing and modifying everything that the body ingests and digests and assimilates, physiologically and psychologically. // fol- lows that the body is the most indisputable materialization of class taste, which it manifests in several ways. It does this first in the seemingly most natural features of the body, the dimensions (volume, height, weight) and shapes (round or square, stiff or supple, straight or curved) of its visible forms, which express in countless ways a whole relation to the body, i.e. a way of treating it, caring for it, feeding it, maintaining it, which reveals the deepest dispositions of the habitus. It is in fact through preferences with regard to food which may be perpetuated beyond their social conditions of production (as, in other areas, an accent, a walk etc.), and also, of course, through the uses of the body in work and leisure which are bound up with them, that the class distri- bution of bodily properties is determined (Bourdieu 1984: 190)

On the one hand, food is perceived as a material reality, a nourishing substance, which sustains the body and gives it strength (hence the emphasis upon heavy, filling, fatty, strong foods). On the other hand, the priority is given to form (the shape of the body for instance) which puts the pursuit of strength and substance into the background, identifying instead true freedom with the 'elective asceticism of a self-imposed rule' (Bourdieu 1984: 199). Again, this is a finding which is echoed in other more recent sociological studies concerning the relationship between class and food consumption - c.f. the difference between 'balanced', 'moderate' diets and 'substantial', 'filling' meals mentioned earlier (Calnan 1990, Calnan and Cant 1990). Indeed, at a broader level, as Bourdieu suggests, this matrix of oppositions contain two antagonist world views involving: 'Substance, as opposed to all appearances', 'reality as against imitation', 'being as against seeming', 'nature and natural simplicity as against embarrassment, posturing, airs and graces' (Bourdieu 1984: 199). In this respect, as Bourdieu suggests, the fact that the main oppositions in the

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realm of food consumption broadly correspond to differences in income, serves to *mask' the fact that:

. . . the real principle of preferences is taste, a virtue made of necessity, the theory which makes consumption a simple fimction of income has all the appearances to support it, since income plays an important part in determining distance from necessity. However, it cannot account for cases in which the same income is associated with totally different consumption patterns . , . The true basis of the differences found in the area of consump- tion, and far beyond it, is the opposition between the tastes of luxury (or freedom) and the tastes of necessity. The former are tastes of the individu- als which are the product of material conditions of existence defined by distance from necessity, by the freedoms or facilities stemming from possession of capital; the latter express, precisely in their adjustment, the necessities of which they are a product. , , Some simply sweep it [taste] aside, making practice a direct [H-oduct of economic necessity (workers eat beans because they cannot alTord anything else), failing to realise that necessity can only be fulfilled, most of the time, because the agents are inclined to fulfil it, because they have a taste for what they are anyway condemned to (Bourdieu 1984: 177-8).

Here again we see the habitus at work in aligning 'subjective expectations with objective probabilities', and the relevance of Bourdieu's analysis in shedding new light upon class-related patterns of food consumption.

Another key aspect of the health and lifestyles debate, of course, con- cerns exercise and participation in sporting activities. In keeping with Bourdieu's general analysis, this too reveals the deepest dispositions of the (class-related) habitus at work, together with the struggle for social distinction. Indeed, as with food consumption, Bourdieu maintains that economic factors are not necessarily the main ones in accounting for the relationship between class and participation in exercise and sporting activities. Rather, the issue is in fact far more complex:

Class variations in these practices derive not only from variations in factors which make it possible or impossible to meet their economic or cultural costs but also from variations in the perception and appreciation of the immediate or deferred profits accruing from the different sporting practices (Bourdieu 1978: 835).

It is on the basis of this that Bourdieu is able to offer the following proposition: '

We can hypothesize as a general law that a sport is more likely to be adopted by a social class if it does not contradict that class's relation to the body at its deepest and most unconscious level, i.e. the body schema, which is the depository of a whole world view and a whole philosophy of the person and the body (1984: 217-8).

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Thus the instrumental relation of the working classes towards their bodies, whether in 'dieting or beauty care', or the relation to 'illness or medication' (Bourdieu 1978: 838), is also manifest in the nature of their 'choices* regarding sport and exercise. Having used their bodies all day in what often amounts to physically demanding work, the working classes may have little time or inclination for the 'pretentions' of exercise such as jogging or 'keep fit' (Shilling 1993). Ind^d, their very definitions of what constitutes 'exercise' and 'fitness' are likely to difTer considerably from their middle class counterparts (Calnan and Williams 1991). As Bourdieu and others have shown (Blaxter 1990), participation in sporting activities tends to decline far more rapidly after school-leaving age amongst the working classes than the middle classes. To the extent that they do engage in certain forms of sport, their choice tends to be directed towards those activities which, as the above quotes suggest, do not contradict their underlying class-related body schemas. Thus the working classes tend to be attracted to those sporting activities which cultivate physical strength (e.g. weight-lifting, wrestling, 'gladiator' competitions), demand a high investment of energy, effort or even pain (e.g. boxing), and which sometimes endanger the body itself (e.g. motor cycling, 'contact sports' etc.).

In contrast, in keeping with their own underlying body schemas which the habitus engenders, the priviiedged classes tend to treat the body as a project; 'with variants according to whether the emphasis is placed on the intrinsic functioning of the body as an organism, which leads to the mac- robiotic of health, or on the appearance of perceptible configuration, the "physique", i.e. the body for others' (Bourdieu 1978: 838). In this respect, the concern to cultivate the body (i.e. the 'cult of health') implies an 'ascetic exaltation of sobriety and dietetic rigour amongst the lower-mid- dle classes', who are prepared to find their satisfaction in effort itself and the deferred satisfaction which present sacrifices will reward (Bourdieu 1978: 838). These groups tend to be less concerned with the production of large, strong, physical bodies, instead seeking to cultivate slim, trim bod- ies which relate to the chances of material or symbolic profit they can reasonably expect within a labour market which valorises physical appearance and presentation of self. As a consequence, the middle classes, particularly women, '. . . are disposed to sacrifice much time and effort to achieve the sense of meeting the social norms of self-presentation which is the precondition of forgetting oneself and the body for others' (1984: 213-14).

Amongst the dominant classes, the purely health-oriented function of the body is combined with the symbolic and aesthetic gratifications asso- ciated with practising in highly distinctive ways. Generally speaking, many of these practices are only meaningful in relation to a quite abstract, theoretical knowledge of the effects of exercise which, in gym- nastics for example; 'is itself reduced to a series of abstract movements,

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composed and organised by reference to a specific erudite goal {e.g. the 'abdominals'), entirely opposed to the total, practically-oriented move- ments of everyday life; they presuppose a rational faith in the deferred, often intangible profits they offer* (Bourdicu 1984: 214). Ever concerned to impose the indisputable image of authority,, dignity, or distinction, the 'bourgois treats his (sic) body as an end, makes his (sic) body a sign of its own ease. Style is thus foregrounded' (1984: 218).

All the features which appeal to the dominant classes are therefore combined in sports such as golf, tennis, sailing, riding, polo, skiing, fenc- ing or mountaineering; practised in exclusive places far away from the 'vulgar crowds', at a time one chooses (Bourdieu 1984: 217). As Bourdieu argues, one only needs to be aware that class variations in sporting activi- ties are due as much to variations in perception and appreciation of the immediate or deferred profits they are supposed to bring, as to variations in costs, both economic, cultural and bodily {i.e. degree of risk and physi- cal effort involved), in order to understand in its broadest outlines, the social distribution of these activities amongst the various classes and class fractions. As the above activities suggest, however it is perhaps worth noting that the types of sports which the dominant classes tend to go in for are not themselves devoid of certain 'bodily risks'.

Moreover, as Bourdieu also points out, whilst different classes and class fractions may indeed pursue similar sporting activities - a trend which looks set to increase in contemporary society - the meaning and function of these activities is likely to differ considerably:

It would not be difficult to show that the different social classes do not agree as to the effects expected from bodily exercise, whether on the outside of the body (bodily hexis), such as the visible strength of prominent muscles which some prefer, or the elegance, ease and beauty favoured by others, or inside the body, health, mental equilibrium etc , . . [For example] . . , gymnastics may be asked to produce either a strong body, bearing outward signs of strength - this is the working class demand, which is satisfied by body-building - or a healthy body - this is the bourgeois demand, which is satisfied by a gymnastics or other sports whose function is essentially hygienic . . . Class habitus defines the meaning conferred on sporting activity, the profits expected from it; and not the least of these profits is the social value accruing from the pursuit of certain sports by virtue of the distinctive rarity they drive from_their class distribution. In short, to the 'instrinsic' profits . . . which are expected from sport for the body itself, one must add the social profits, those accruing from any distinctive practice, which are very unequally perceived and appreciated by the different classes (Bourdieu 1978: 835-36).

Thus, whilst social fields such as sport may suggest a far more 'fluid' position, Bourdieu is nonetheless able to point to important economic, O Blackwell Publishers Ltd/Editorial Board 1995

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social and cultural 'constraints', together with the differential dispositions and schemes of valuation underlying such lifestyle 'choices'. In this sense, whilst similar sporting activities may indeed be pursued, their meanings and functions are likely to be very different according to social class membership.

Finally, Bourdieu's analysis, whilst not blind to the issue, has also been interestingly developed by Featherstone (1987b, 199!) in relation to the differing class attitudes toward 'ageing bodies'. As Arber (1994) argues, ageing has, until fairly recently, tended to be a somewhat neglected topic in (medical) sociology, and yet it is clearly of central importance to the study of health, illness and the body. In this respect, as Featherstone (1987b) suggests, whilst the working classes may come more readily to accept bodily decline as inevitable, the 'new' middle class tend to be highly anxious about their ageing, engaging in a variety of body mainte- nance techniques designed to combat and control the ageing process. Indeed, according to Featherstone (1987a), it is Bourdieu's 'new petite bourgeoise' who are the central carriers of what has come to be called the 'stylisation of life' in consumer culture. In contrast, however, the upper classes tend to have acquired orientations towards their bodies, through the habitus and bodily hexis, which can overlay and disguise many of the negative effects of ageing; choosing instead to 'wear' their age unselfcon- sciously as a mark of social distinction rather than decline (Shilling 1993: 140). Indeed, as Featherstone states in typically Bourdieuesque style,

. . . the movement into old age necessarily involves a shedding, a reduction of the capacity to accumulate economic capital and a devalu- ation of particular types of cultural capital (by dint of attachment to forms of knowledge and styles which have become deemed as out- moded). At the same time certain types of capital, manifest in demeanour, ways of speaking and attitudes towards the body [bodily hexis], may retain their distinction and value deep into old age (Featherstone, 1987a: 125, quoted in Shilling 1993: 139).

Thus, as this quote clearly iUustrates, Featherstone usefully extends and develops Bourdieu's concem with class struggles in arguing that age is also an important factor in structuring the competition between differing social groups to define their bodies as possessors of symbolic value and social distinction. In this respect, as Shilling (1993) notes, whilst certain struggles between working class males may be resolved in terms of physi- cal strength, age-group conflicts within the middle class may involve struggles over the very definition of when old age begins.

To summarise, the implications of Bourdieu's analysis are clear, whether one is looking at concepts of health in particular or lifestyles more generally, it is the (class-related) habitus which, through taste and the bodily dispositions it engenders within particular social fields, together with the volume and composition of capital, determine not only

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lifestyles and the chances of success in the symbolic struggles for social distinction, but also class-related inequalities in health and illness. Hence, it is to a fuller discussion of these issues, and the relevance of Bourdieu's work for understanding the relationship between class, health and life- styles that this paper now turns in closing.

Disci^ion and concludi^ remarks

What then, does all this tell us about health-related behaviour? In answering this question I hope to spell out the implications of the forego- ing discussion not only for understanding health-related behaviour, but also for explaining the relationship between class, health and life-styles more generally. In this respect, the following key points emerge.

First, Bourdieu's discussion of practical logic and the logic of practice offers a potentially very fruitful way of understanding the nature of everyday lifestyles and health-related behaviours. As we have seen, much of our daily life is predicated upon taken-for-granted, routinised knowl- edge and practices which, for the most part, we carry out unthinkingly and unreflectively. This is not, of course, to say that the logic of everyday practice is devoid of intent, or that it cannot, at times, be consciously motivated; quite the reverse. It does suggest, however, that the logic of practice works largely 'outside conscious control and discourse', and that because of this very fact, what we do has more significance than we know. It is here that the crux of the argument lies, as much of what we conventionally call, 'health-related behaviour' - itself a second-order ana- lytical construct - is part and parcel of this implicit, routinised, practical logic of daily life. This is a contention which, as we saw, finds further support in recent empirical work (Calnan and Williams 1991). Indeed, it would not perhaps be too bold an assertion to suggest that if one prefixes all of what has been said about practice with 'health-related', we may go some way towards solving the puzzles of health and lifestyles. In other words, much of Bourdieu's argument concerning the logic of practice and its determinants can profitably be used in order to understand and explain health and lifestyles.

Secondly, and very much related to this first point, the division between practical logic and the discourses on practice which this argu- ment implies, also sheds important new Hght on the seemingly paradoxi- cal finding that people tend to reproduce the conventional wisdorn of health education and health promotion when asked about their health and lifestyles (Blaxter 1990, 1993), but don't seem to implement it in practice. In other words, the gulf between accounts and actions becomes somewhat less of a puzzle when we realise that much of people's daily lives is, in fact, governed by an implicit, practical logic and that, as a consequence, there is a tendency in the research context to switch from © Blackwell Publishers Ltd/Editorial Board 1995

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this level of practical logic, to a more discursive form of consciousness; one which bears little relationship to former type of knowledge and tends to be more concemed with 'mentioning the mentionable' and appearing in a favourable moral light. Certainly within medical sociology, there is now ample evidence to support the validity of these arguments {c.f. Corawell's (1984) distinction between 'public' and 'private' accounts). In the hands of Bourdieu and Giddens, however, these arguments take on a rather wider, more profound, significance, implying as they do that much of our daily lives is accomplished in a practical, unreflective fashion which discourse or discursive consciousness only dimly reflect. I shall retum to the problems of agency which this issue raises shortly.

The third issue, of course, concems the importance of the habitus, body-schemas and the search for social distinction in understanding and explaining health and lifestyles. As we have seen, the power of the habi- tus for Bourdieu derives from the largely thoughtless nature of practice and habit, rather than from consciously leamed rules and principles. Moreover, the habitus is itself formed in the context of people's social locations and, as such, it 'inculcates' them into a 'world view' which is based upon and reconciled to their position, thus serving to reproduce existing social structures. More specifically, it is in the relationship between habitus and capital, located within the context of the different social fields of society {i.e. the relationship between position and disposi- tion) and the struggle for social distinction, that lifestyles are constructed. In short, the formula which Bourdieu proposes runs as follows: '[(habi- tus) (capital)J + field = practice' (1984: lOI). This equation has the dis- tinct merit of linking agency (i.e. practice) and structure {i.e. capital and field) through the habitus in a dynamic approach which is not blind to historical change at both the individual and societal levels. In this sense it offers an altemative version of what Giddens (1984) has termed 'struc- turation theory'.

Leaving aside for the moment any possible objections, to which I shall return very shortly, the power of Bourdieu's argument for the class, health and lifestyles debate surely lies in the manner in which it is able to explain the relative durability of differing forms of health-related behaviour, or 'practice', amongst the social classes, and to do so in a manner which not only links structure and agency, but also adds a further dimension to the debate; namely, the way in which health and lifestyles are caught up in struggles for social recognition and distinction, and the 'symbolic violence' which the dominant classes exercise over the 'vulgar' bodily forms and prac- tices of the working classes. In addition, Bourdieu's analysis serves to remind us that whilst economic factors (or in Bourdieu's terms economic 'capital') are clearly an important part of the (health and lifestyles) equation, 'taste' and the underlying body-schemas which the habitus engenders are also important issues to consider. For example, as we have seen, they exert a powerful, albeit largely unacknowledged, influence upon class-related

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concepts of health, patterns of food consumption and participation in exer- cise and sporting activities, as well as attitudes towards 'ageing bodies'. As Bourdieu argues, the habitus engenders a *taste for the necessary', adjusting 'subjective expectations to objective probabilities', and steers people into food choices and exercise and sporting activities which are largely congruent with their underlying body schemas. Moreover, whilst Bourdieu does not directly address the issue of social class inequalities in health, the merit of his analysis lies in the way in which he is able to link together, in a theoreti- cally meaningful way, both lifestyle choices {i.e. agency) and their broader material, social, cxUtural and symbolic determinants (i.e. structure); factors which, as existing evidence suggests, are likely to aHect health both jointly and independently of one another (Blaxter 1990).

Within all this, it is clear that the (class-related) body is of crucial importance, and there is a general need to make the body a far more cen- tral topic of enquiry within the sociology of health and illness. This is the fourth point I wish to emphasise. As with sociological theory more gener- ally, the body has until quite recently enjoyed a rather 'ethereal' existence within medical sociology (Turner 1984, 1992). Clearly there are excep- tions; one thinks immediately of feminist theories concerning medicine and the body, the influence of Foucauldian thought, and the sociological literature on chronic illness and disability. Nevertheless, the tendency to relegate the body to biology, and the desire on the part of medical sociol- ogy to distance itself from the biomedical model through tactics such as the disease/illness distinction, has led to a relative neglect of the body and the corporeal basis of health and illness within medical sociology (Turner 1984, 1992, Kelly and Field 1994). The argument here is not for a 'sociol- ogy of the body', however, but that sociology itself needs to be funda- mentally 'embodied'. Indeed, not only may a more explicit and thorough-going focus upon the body shed new light on the class, health and lifestyles debate, it also opens up important and exciting new areas and avenues of inquiry, such as the sociology of pain and emotions (Bendelow and Williams 1994, 1995).

Yet, as has been discussed throughout the course of this paper, Bourdieu's analysis of these issues is not without its problems. In particu- lar, it has been suggested that Bourdieu's approach may under-estimate the fluidity and dynamism of lifestyle (re-)construction in 'high' moder- nity (Giddens 1991) and consumer culture (Featherstone 1991), and that his quest for unity, systematicity and stable patterns of consumption neglects the fact that lifestyles, in reality, are a 'critical mess'.

On a related note, participating in ostensibly 'pathogenic' or 'risky' forms of behaviour may well involve some kind of 'refiexive' protest or statement about the social, economic and power relations which charac- terise contemporary forms of collective social life. This again suggests a far more critical, refiexive notion of agency; one in which individuals do not simply conform to the dispositions of the habitus in an unthinking ® Blackwell Publishers Ltd/Editorial Board 1995

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way, but instead actively construct (and challenge) their social world through a variety of means (some of which may involve them 'stepping outside' their habitus). Thus, for example, as Wearing and colleagues (1994) have recently shown, smoking amongst adolescent women may not only be a form of resistance to the 'good girl' image of passivity and compliance, but also a response to a lack of leisure opportunities. This notion of 'resistance* is also, of course, central to Foucault's (1982) later writing in which he attempts to develop a 'critical ontology of self rooted in the aesthetic stylisation of life as a challenge to 'normalising' forms of power/knowledge. Indeed, for Foucault, wherever there is power, there is also resistance. In short, the upshot of these arguments suggests that a potentially fruitful line of future inquiry in the class, health and lifestyles debate would be to focus less on conformity and stability and more upon reflexivity and cultural resistance.

To end the paper on this note, however, would be to do Bourdieu a gross injustice. Clearly, as I have suggested throughout the paper, his analysis does have merit on a number of counts. In particular, the manner in which his arguments are wedded to an analysis of the inter-relationship between class, capital, taste and the body in the construction of lifestyles and the struggle for social distinction across the various social fields of society, is both compelling and convincing. Moreover, as we have seen, 'change', although circumscribed, is not in fact ruled out in Bourdieu's analysis, and there remains a certain dynamism to his discussion of lifestyle construction and the search for social distinction. Indeed, one of the defining characteristics of Bourdieu's 'fields' are the struggles between different classes and class fractions for the particular fonn(s) of capital at stake. Furthermore, as I have argued, in drawing attention to the struc- tural 'constraints' (physical, economic, social and cultural) and social dynamics of lifestyle (re-)construction, Bourdieu's provides an important counter-weight to those more recent perspectives which see these issues simply in terms of personal choice and reflexive control. In this respect, what is really required is an approach which recognises the dialectical interplay of freedom and constraint in daily life and accords equal weight to both elements. Whether you end up accepting or rejecting Bourdieu's analysis, however, it is nonetheless an instructive exercise concerning the useful insights which can be gained from building bridges between main- stream theory and medical sociology. Let us hope that this paper serves as the necessary catalyst for further exercises of a simitar nature in the future; certainly the intellectual fruits are there for the takers!

Address for correspondence: Dr. Simon J. Williams, Department of Sociology, University of Warwick. Coventry, CV4 7AL

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