THEORIZING INEQUALITIES IN HEALTH - THE PLACE OF LAY KNOWLEDGE

This paper contributes to the development of theory and research on in equalities in health. Our central premise is that these are currently limited because they fail adequately to address the relationship betwe en agency and structure, and that lay knowledge in the form of narrati ve has a significant contribution to make to this endeavour. The paper is divided into three sections. In the first section we briefly revie w the existing, largely quantitative research on inequalities in healt h. We then move on to consider some of the most significant critiques of this body of work highlighting three issues: the pursuit of overly simple unidimensional explanations within 'risk factor' epidemiology a nd the (probably inevitable) inability of this research tradition to e ncompass the full complexity of social processes; the failure to consi der the social context of individual behaviour and, in particular, the possibility for, and determinants of, creative human agency; and, thi rdly, the need for 'place' and 'time' (both historical and biographica l) to be given greater theoretical prominence. In the final section of the paper the potential theoretical significance of 'place' and 'lay knowledge', and the relationship between these concepts, in inequaliti es research is explored. Here we suggest three developments as a neces sary condition for a more adequate theoretical framework in this field . We consider first the need for the conceptualisation and measurement of 'place' within a historical context, as the location in which macr o social structures impact on people's lives. Second, we argue for a r e-conceptualisation of lay knowledge about everyday life in general an d the nature and causes of health and illness in particular, as narrat ives which have embedded within them explanations for what people do a nd why - and which, in turn, shape social action. Finally, we suggest that this narrative knowledge is also the medium through which people locate themselves within the places they inhabit and determine how to act within and upon them. Lay knowledge therefore offers a vitally imp ortant but neglected perspective on the relationship between social co ntext and the experience of health and illness at the individual and p opulation level.