Whereas theories on health generally argue in favor of one specific concept, we argue that, given the variety of health practices, we need different concepts of health. We thus approach health concepts as a Wittgensteinian family of thick concepts. By discussing five concepts of health offered by (philosophical) theory, we argue that all capture something that seems relevant when we talk and think about health. Classifying these concepts reveals their family resemblances: each of these concepts differs from the others in at least one respect and resembles the others in several respects. Moreover, our classification shows that "health" always both describes a condition and evaluates that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as "thick concepts." It is because of this evaluative dimension that it is important to reflect on the question of what understanding of health guides specific practices. We show that the distinctions revealed by our classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of particular health practices. Finally, we illustrate how such reflection could work out by briefly exploring three specific health practices.

ObjectivesThe legitimacy of policies that aim at tackling socioeconomic inequalities in health can be challenged if they do not reflect the conceptualisations of health that are valued in all strata. Therefore, this study analyses how different socioeconomic groups formulate their own answers regarding: what does health mean to you?DesignConcept mapping procedures were performed in three groups that differ in educational level. All procedures followed exactly the same design.SettingArea of the city of Utrecht, the Netherlands.ParticipantsLay persons with a lower, intermediate and higher educational level (±15/group).ResultsThe concept maps for the three groups consisted of nine, eight and seven clusters each, respectively. Four clusters occurred in all groups: absence of disease/disabilities, health-related behaviours, social life, attitude towards life. The content of some of these differed between groups, for example, behaviours were interpreted as having opportunities to behave healthily in the lower education group, and in terms of their impact on health in the higher education group. Other clusters appeared to be specific for particular groups, such as autonomy (intermediate/higher education group). Finally, ranking ranged from a higher ranking of the positively formulated aspects in the higher education group (eg, lust for life) to that of the negatively formulated aspects in the lower education group (eg, having no chronic disease).ConclusionOur results provide indications to suggest that people in lower socioeconomic groups are more likely to show a conceptualisation of health that refers to (1) the absence of health threats (vs positive aspects), (2) a person within his/her circumstances (vs quality of own body/mind), (3) the value of functional (vs hedonistic) notions and (4) an accepting (vs active) attitude towards life.

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Gezondheid': voor iedere context een passend concept? (noot a) 25 Samenvatting 26 Het antwoord op de vraag wat we onder gezondheid verstaan, heeft implicaties voor beleid en 27 praktijk in de gezondheidszorg. De discussie die wordt gevoerd naar aanleiding van het als nieuw 28 voorgestelde gezondheidsconcept door Machteld Huber en anderen, illustreert dit. In dit artikel 29 vergelijken we vijf verschillende gezondheidsconcepten met elkaar, en exploreren we hun implicaties 30 voor beleid en praktijk in de gezondheidszorg. 31Onze vergelijking van gezondheidsconcepten toont dat de betekenis van 'gezondheid' zich niet laat 32 vangen in één definitie: ieder concept stelt verschillende aspecten van gezondheid centraal. 33Bovendien is de vraag wat we verstaan onder gezondheid een deels normatieve vraag, daar de term 34 'gezond' niet alleen een bepaalde conditie beschrijft, maar deze ook als wenselijk voorstelt. Omdat in 35 iedere specifieke context andere condities als nastrevenswaardig kunnen worden gezien, lijkt het 36 zinnig om per context te bepalen welke aspecten van gezondheid centraal zouden moeten staan. Op 37 basis van onderscheidingen die in een vergelijking van de vijf gezondheidsconcepten naar voren 38 komen, formuleren we zes vragen die richting kunnen geven aan het denken over de vraag welk 39 gezondheidsbegrip leidend zou moeten zijn in een bepaalde context. Een casusbespreking maakt 40 duidelijk dat definitieve beantwoording van deze vragen altijd additionele praktische en normatieve 41 afwegingen vraagt. (199) 42 Trefwoorden: gezondheidsconcepten, kritische reflectie, beleid en onderzoek 43 Kernpunten: 44 -De vraag wat we verstaan onder gezondheid is van belang om kritisch naar beleid en 45 onderzoek te kunnen kijken.46

Socioeconomic health inequalities as a political concernAlthough only in the last decennia problematised as a matter of 'health inequity', the correlation between health and occupation, income and/or education levels, is known to exist since ages. Before governments existed, Chapter 1 12 However, in 2003, the Dutch government was criticised by the Netherlands Court of Audit for taking insufficient action regarding socioeconomic health inequalities (Tweede Kamer 2003). In response, the Dutch government repeated its ambition to reduce avoidable socioeconomic health disparities by raising the life expectancy of the lower socioeconomic groups with three years (Ministry of Health, Welfare and Sports 2003). Nevertheless, health inequalities received hardly or no attention by the governments that followed. This silence was broken by Parliamentary questions in 2008, in response to which the Minister of Health presented an elaborate policy strategy to reduce socioeconomic health inequalities both improving structural factors, such as neighbourhoods and social participation, and stimulating healthy lifestyles.The proposals to address socioeconomic health disparities were explicitly motivated by a concern for 'social justice' (Ministry of Health, Welfare and Sports 2008). Despite these ambitious plans on paper, their effects appeared to be minimal (Broeders et al. 2018). Life expectancy overall has increased, but inequalities in health have persisted. It is in the light of their persistence that we can understand the recommendation of the Netherlands Scientific Council for Government Policy (WRR) to shift the focus in public health policies from aiming to reduce health inequalities to trying to utilise the health 'potential' of the whole population (Broeders et al. 2018). Inspired by Michael Marmot's 'proportionate universalism' -the idea that public health measures should address the entire population but in proportion to the degree of the health needs of specific groups (e.g. Marmot et al. 2010), the WRR argues to give extra attention to lower socioeconomic groups.In the year 2018, the Dutch Minister of Health, Welfare and Sports announced the 'Nationaal Preventieakkoord'. At the time of writing this introduction, it is unclear yet to what extent addressing socioeconomic health inequalities will be a central policy aspiration. Epidemiological attention to socioeconomic health inequalitiesSocioeconomic inequalities in health are often believed to have emerged after the ending of the great epidemics, in 17 th and 18 th century Europe, at a time when improvements were made in terms of nutrition, housing and private and public hygiene. That is, improvements in factors that were unequally This agreement comes with a shift from talking about poverty to talking about relative socioeconomic position. In this regard, the Whitehall Studies -started at the end of the 1960s in the UK -played an important role. By recording mortality and causes of death of about 17500 civil servants working at the London Whitehouse, a 'social gradie...