Module 1, Imagining Health Problems as Social Issues - Intro to Biomedical and Social Models

Question 1

Health

Answer 1

the state of being free from illness - oxford english dictionary (you are healthy if you are not sick)

health is a state of complete, physical, mental and social well-being and not merely the absence of disease or infirmity - world health organization

Question 2

Implications of WHO definition

Answer 2

• health is not just absence of something
• health something we have (or do not have)
• introduces the concept of mental and social wellbeing in addition to physical health

Question 3

What are the Two Models?

Answer 3

historically, there have been two approaches to considering health in western societies: a biomedical model and a social model

Question 4

What is the biomedical model of health?

Answer 4

• based on the diagnosis and explanation of illness as a malfunction of the body’s biological mechanisms (some healthy norm or body that we can reference) - ill health in the malfunction
• underpins most health professions and health care services
• focus is on treating individuals - not the origins of illness (the answer to poor health is to treat the body and individual)

Question 5

Origins of Biomedical Model

Answer 5

cartesian mind/body dualism
- refers to french philosopher rene descartes (1596-1650)
- the notion that the body is a physical material object that was “unthinking” whereas the mind lacks material substance but is “thinking” and the location of “self”
- i think, therefor i am
- there is something that animates us (our sense of self is not our physical body and that is the us)

Question 6

Implications of the Biomedical Model

Answer 6

• disease and illness is seen as situated in the body (health is the body and not holistic)
• legtimizes body as the purview of doctors and other medical proffesionals
• mind/spirit remain in the purview of religiuous authorities and philosophers (spiritual matters does not interfere with health in this model, allowing for advancements in practice of medicine like biology, anatomy)
• subjective aspects of illness are largely ignored (emotional aspects are ignored as doctors are focused on the body)

Question 7

Assumptions of the Biomedical Model (5)

Answer 7

1. doctorine of specific etiology
2. the body as a machine
3. reductionist
4. narrow definition of health
5. treatment imperative

Question 8

Assumption of the Biomedical Model Doctorine of Specific Etiology

Answer 8

• doctrine” refers to a set of beliefs or teachings. “etiology” refers to a cause or an origin. The doctrine of specific etiology is the belief that for each disease there is a specific cause. This explains how the biomedical model endorses a view that illness can be understood by looking for a singular cause within the body
• disease has a specific cause and if we find it we can treat it (in the pursuit of disease and science we can cure the body)

Question 9

Assumption of the Biomedical Model - The Body as Machine

Answer 9

• the biomedical model views the body as comprised of smaller parts. the parts work together in the same way the parts of a machine work together
• notion that the body is made up of specific parts and when they are all working together the machine is healthy (understand the functions of the parts and make sure they are functioning)
• reductionist model

Question 10

Assumptions of the Biomedical Model - Reductionist

Answer 10

the biomedical model of health suggests that diseases can be “reduced” to causes within the body. it fails to account for causes of disease that are complex and include societal and environmental factors

Question 11

Assumptions of the Biomedical Model - Narrow Definition of Health

Answer 11

• “health” in the biomedical model is the absence of disease. an individual is either healthy or not healthy
• seen in the oxford dictionary
• if everything is doing its part that is a healthy body

Question 12

Assumption of the Biomedical Model - Treatment Imperative

Answer 12

• the biomedical models assumes that individuals should seek treatment. there is also a bias in favour of drugs or medical devices that are seen as “silver bullets” to cure disease rather than preventative measures such as changes to a person’s environment or behavioural interventions
• does not lead to a focus on societal measures that reduce the cause of the disease in the first place

Question 13

Limits of the Biomedical Model

Answer 13

• illness is rarely as simple as suggested by biomedical model (never ‘one cause’)
• focus on repairing ‘broken’ parts can lead to objectification of patients
• patients treated like ‘cases’ rather than individuals
• revere scientific measurements over subjective experiences of illness
• victim blaming - health is individual tragedy and attribute to poor choices or poor chance (if you got sick your body failed you rather than how society may have failed to protect you)

Question 14

History of the Social Origins of Illness

Answer 14

• emergence of ‘social medicine’ or ‘public health’ in mid-19th century
• clear links established between disease and poor living or working conditions
• not everyone has the same health and the disease can be traced back to the conditions they are living in

Question 15

Start to understand that health is influenced by..

Answer 15

environmental factors (housing, food security, pollution)
social factors (health care, money, education)
cultural factors (diet, hygiene)

Question 16

Development of field of ‘epidemiology’

Answer 16

• epidemiology = the statistical study of patterns of disease in population
• ‘epidemics’ of infectious disease
• difference in mortality rates between groups
• social epidemiology is subfield of sociology that focuses on social determinants of health (looking for patterns and relating them back to social factors specifically)
• these patterns of disease can tell us about our social settings and the conditions we lived in

Question 17

The Social Model of Health

Answer 17

• focuses on social patterns of health and illness and societal level of health determinants
• draws primarily on health sociology (rather than medical science)
• health (or lack of) are considered a result of one’s social context and are socially experienced
  ◦ who gets sick matters but how
  we react when people are sick,
  who has access to healthcare,
  who gets time off
• the biomedical model concentrates on treating disease and risk-taking or illness-causing among individuals
• the social model concentrates addressing societal factors that are risk-imposing (societal factors that put some people at risk) - put people at risk based on how we arrange our societies
• highlights the health inequalities experienced by social groups based on class, gender, ethnicity, race, occupation and more
• attempts to improve health by addressing material conditions
• equal priority on treating and preventing illness (changing the conditions that lead to illness or poor health and leading to enhancing them)

Question 18

What are the 3 Dimensions of Social Model?

Answer 18

1. societal production and distribution of illness
2. social construction of health and illness
3. social organization of health care

Question 19

Dimension of Social Model - Social Production and Distribution of Illness

Answer 19

• many illnesses that individuals suffer from are due to material conditions - are linked to our social arrangements
• unequal distribution of wealth and resources are important determinants of health - can know a lot about someone’s health if we know where they live, how many they are paid, what kind of house etc. (social production of illness - we create these situations depending on how we distribute resources)

Question 20

Dimension of Social Model - Social Construction of Health and Illness

Answer 20

• definitions of health and illness vary over time and from culture to culture. notions of health and illness are not static facts but social constructions that reflect culture, politics, morality of given society (mental health was not considered a form of illness back in the day)
• change the measures we use for diagnostics overtime - social decision

Question 21

Dimension of Social Model - Social Organization of Health Care

Answer 21

• society organizes, funds and utilizes health services in particular ways. our health system (policy and delivery) has been developed to support and deliver Western medicine
• largely been developed to support a biomedical level (individual level)

Question 22

Limits of the social model

Answer 22

did the pendulum swing too far?
- the emphasis on societal causes can detract from exploring biological causes
adopting a social model does not mean that illness is not also physiological and biological!
- presenting two different ways of thinking of health that does not deprive one of the other

Question 23

Limits of the social model (2)

Answer 23

social model is complex!
- proposed solutions can be complex and difficult to implement (particularly in short term)
- we often know the problem but are unable or unwilling to address it
- biomedical responses are more direct and rapid
- the social model encourages us to think broadly which can lead it to lack focus