To begin with, it is useful to consider two fundamental theoretical constructs of health – the medical model of health and the social model of health.
The medical model
The medical model of health is located within a scientific paradigm of understanding. It is sometimes also referred to as the ‘biomedical’ model (Blaxter, 2010), the medical model, the ‘biological’ model or even the ‘Western scientific medical model’. The medical model draws on scientific, mechanical, individualistic and reductionist understandings of what health is and views health in terms of pathology, disease, diagnosis and treatment. The physical body is viewed as being separate from social or psychological processes, sometimes referred to as ‘mind–body dualism’ (Green et al., 2019: 31). Health is seen as being ‘located’ in the individual body and the causes of ill-health are viewed as being biological or physiological in origin, requiring expert intervention. Health, according to a medical view, is conceived of as the absence of disease or ‘abnormality’. If medically defined illness and disorder are absent then health is assumed to be present. The medical model is, and has been, very influential in terms of understandings of what health is. The dominance of ideas of health as ‘the absence of illness’ in mainstream discourse about health is testimony to this. The medical model does, however, have some distinct advantages and through technological advances in scientific knowledge it has been extremely influential in Western societies within the last two centuries. As a result the medical model of health forms the basis of much health-care provision within these contexts.
However, the medical model of health has faced heavy criticism. One of the main criticisms is that the wider context is given little attention and therefore the numerous social, psychological and environmental factors that influence, or determine, health are not considered. It is difficult to account for the complexity of health if we consider it solely in biological terms, using the medical model. Another criticism of the medical model is that its view of health as the absence of disease or abnormality can be seen as being rather negative (Earle, 2007a). Surely health is about more than just this? Are we necessarily healthy simply because we are not ill? However, this is problematic because, as Duncan (2007: 8) argues, one of the main difficulties with arguing that health is about more than simply the absence of disease or abnormality is that this can lead to ‘muddle and confusion’, which may render meaningful description ‘impossible’. In addition, the widespread use of the medical model of health has increased perceptions that the responsibility for health, and indeed the control of it, lies with the individual (Jackson, 2007). This is a position that is reflected in more contemporary neo-liberalist stances in the Western world that emphasize personal responsibility for health (Friesen, 2017). This position is challenged by other concepts of health such as the social model, which will now be discussed in more detail. Before we move on to the next section take some time to carry out learning task 1.3.
Influences upon health
1 Take a few minutes to reflect on all of the things that you think impact on, and influence your health. Write them down.
2 Can you spot any patterns or group the different influences in any way?
When you have completed this task, see part III of this book and particularly chapter 13 for Dahlgren and Whitehead’s (1991) rainbow model of health determinants. Are there influences that you had not thought of?
The social model
In contrast to the medical model of health the social model of health views health as being influenced by a range of different factors, including those that are political, economic, social, psychological, cultural and environmental (as well as biological) (Earle, 2007a). The causes of ill-health are attributed to factors outside the physical body – the wider structural causes, such as inequality and poverty, as well as factors such as social interaction and behaviour. The notion of health is seen as being socially constructed, which is central to the social model of health and this idea is discussed in more detail later in the chapter.
The social model operates from the view that a wide variety of factors need to be taken into account when conceptualizing health – factors such as the environment, influences on lifestyle choices, access to health-care services, employment status and gendered identities, for example. The social model recognizes individual differences in health experience as being socially produced. In addition, it seeks to provide explanations for why differences exist. Crucially the social model of health also takes into account lay perspectives about health, which are discussed in more detail later in this chapter.
The social model of health is not without its critiques. It has been criticized for being so broad a model as to render it almost unusable. Kelly and Charlton (1995) argue that the social model cannot necessarily be viewed as superior to the medical model, despite criticisms of it. For example, they point out that while health promotion is premised on a social model of health in terms of the way that health is conceived (holistically), the discipline still relies heavily on expert knowledge that can be traced back to scientific origins. Therefore, science (and the medical model of health per se) has its part to play in understanding about the nature of health. The social model has also been criticized on the basis that the breadth of understanding it takes into account may lead to practices in health promotion and public health that have different priorities and therefore can only be implemented on a small scale. Earle (2007a: 54) therefore suggests that, rather than being able to pin down the ways that the social model of health may be used to, for example, improve or promote health, the ‘rhetoric’ of the social model of health has been used in the following ways:
– as a set of underlying values (philosophical approach to health)
– as a set of guiding principles to orientate health work in a specific way
– as a set of practice objectives
In summary, the medical model views health as derived from biology, so ill-health is caused by biological factors that can be identified, diagnosed (as compared with a scientifically defined ‘norm’) and treated by expert medical knowledge. In contrast, the social model of health views it as socially constructed and influenced, so ill-health is caused by social factors, knowledge about ill-health is not confined to medical expertise and a more holistic, less reductionist view of health is subscribed to. Table 1.1 highlights the key differences between these two models.
The importance of social factors and the social model of health is demonstrated in Dahlgren and Whitehead’s (1991) rainbow of determinants (see part III, especially chapter 13).
Table 1.1 The medical model of health compared with the social model of health
| Medical model | Social model |
|---|---|
| Narrow or simplistic understanding of health. | Broad or complex understanding of health. |
| Medically biased definitions focusing on the absence of disease or disability. |
|