Each of the sessions provided information on the study aim/background, the usual rules for brainstorming and the focus of the concept mapping procedure. One concept mapping session was arranged for each educational group (in Spring 2015) these sessions lasted about 4 hours each. Therefore, this study aims to contribute to this body of knowledge by analysing how different socioeconomic groups formulate their own answers to the question: what does health mean to you? However, knowledge in this field is limited regarding both the number of studies performed and the context in which they were performed as well as the methodology used. The latter finding was confirmed in a study by Peersman et al, 8 in which people were asked what conceptualisation of health they had in mind when answering the well-known single-item question on self-rated health. For example, d’Houtaud and Field 7 show that, in the lower socioeconomic groups, respondents emphasised health as the absence of sickness, whereas in higher socioeconomic groups health tended to be defined in terms of vitality. 5 6 Indeed, the few studies that investigated how health is conceptualised across social strata indicate relevant differences. 4 Given its evaluative dimension, the way people conceptualise health may differ between socioeconomic groups, to the extent that different socioeconomic groups are disposed to different practices (eg, value eating three meals a day or not), which in turn may be shaped by differences in living conditions (eg, availability of time and money to spend on dining). Health is a so-called ‘thick concept’, that is, its meaning has both descriptive and evaluative dimensions, in the sense that ‘health’ describes a condition which is at the same time valued. For instance, if policies tacking health inequalities primarily aim at closing the gap in mortality, while people subjected to those policies understand health primarily as ‘health-related quality of life’, it is questionable whether the policy-focus on mortality has sufficient public support.

From a policy perspective, this is an important issue: the legitimacy of policies that aim at improving the health of people in lower socioeconomic groups can be challenged if these policies do not reflect the conceptualisations of health that are valued in all strata. 1–3 However, less research has focused on how people from different social strata conceptualise health. There is considerable evidence for socioeconomic inequalities in health within countries, to the disadvantage of people in lower socioeconomic groups.

Social strata