In sociology, although we understand the meaning of health and illness, sociologists find it very difficult to have a clear definition of health. Many sociological researches find it easier to identify health rather than define it and this by looking at actual issues of ill health. The World Health Organisation (WHO) gave a combined negative as well as positive definition of health. Health is defined as a negative by absence of disease whilst positively it looks at a person holistically i.e. physically, mentally, and spiritually as well as at the social well-being. The WHO’s definition of health (1948) states that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Moreover, according to Mildred Blaxter’s (1990) discussion about health, the latter is not only negative by absence of disease or positive but also functional i.e. the ability to cope with everyday activities (Bury, 2005).
Different sociologists have drawn two conceptual models of health: the biomedical model and the socio-medical one. The biomedical model of health is a negative concept since it regards health as the absence of disease whereas the socio-medical model of health is considered as positive because it emphasises on an individual’s social factors that contribute to health and well being in the society.
What are the main points in the biomedical model of health, its usefulness and weaknesses?
The biomedical model of health is seen as a narrow or simplistic understanding of health. Indeed, it focuses on individuals’ welfare by looking at how to remove their illness through diagnosis and effective treatment. It looks at the human body as a machine, which needs to be fixed if something goes wrong and where medication or treatment is provided to end what does not work well (illness). This approach of health is widely used and practiced in many western countries including the UK by the National Health Service (NHS). Indeed, this is due to the usefulness of the biomedical model of health, which has multiple strengths. For example, it has been widely efficient since doctors use scientific proved methods to decide whether an individual is ill or not. Illness is understood by the biomedical model of health as a temporary condition caused by physical symptoms. This contributes in developing diagnosis and treatments as well as assessing precisely the affected area of dysfunction in the individual’s body.
However, the main areas of the biomedical approach to health are subject to a number of criticisms. As an example, doctors are unknowledgeable about how to treat many of the main mortality causes, such as coronary heart disease and diabetes. In the 21st century, these types of disease depend very much on a person’s actions, beliefs and lifestyles. Indeed, the biomedical model failed in looking at environmental factors as well as sociological determinants of health such as income and so forth.
Contrastingly, what are the main points in the socio-medical model of health, its strengths and limits?
Conversely, the socio-medical model of health is seen as a broad and complex understanding of health. Actually, it focuses on the environmental and social factors that contribute to health and well being in the society. Indeed, many researches revealed that if the environment where a person lives improves, this would improve his chance of being healthy and fit. Poverty, low income, poor housing, unhealthy diet and pollution are examples of factors that might affect people’s health and contribute to their illness. Although the socio-medical approach does not focus on disease like the biomedical model, it is useful as it considers improvement in people’s environment and therefore decreases factors of illness and diseases. Health is seen as a collective responsibility of the society and also as an issue that needs to be tackled by adopting a healthy lifestyle.
However, the socio-medical model has its limits. Because of the multitude of factors, the full implementation of the socio-medical approach to health is unimaginably costly and therefore almost impossible. For example, it would be very difficult for the politicians to guarantee a decent and fair housing for each and every Londoner. This inequality is inevitable as everyone is different in terms of age, gender, physically, culturally and ethnically.
What are the main differences and similarities between the biomedical and socio-medical models of health?
The main differences between the biomedical and socio medical models are that the biomedical model focuses on the individual’s illness whereas the socio-medical model focuses on the environmental and social factors that cause that illness. Additionally, the biomedical claims that health is absolute meaning that a person is either healthy or sick. Contrastingly, the socio-medical model considers not being healthy is relative, presents a deviation from some norm and its symptoms can be perceived differently from one to another.
Although, these two approaches are distinctively different, they are complementary in studying health and illness. They also share the same aim, which is to cure sick people by either looking at the individuals or/and the environment they live in.
How do sociological perspectives, functionalism and Marxism, see health and illness and how are these perspectives related to both models of health?
Doctors, nurses and other health professionals play an important role in curing illness and promoting health (Barber, 1963). Indeed, by understanding how our society is functioning sociologists have also tried to comprehend the role and position of health professionals in curing individuals’ illness. We can identify two main structuralist theoretical perspectives that discuss the aspect of sociological health and illness.
The first one is the consensus functionalist approach and the sick role, which was introduced in the 1950s by Talcott Parsons. Parsons believes that in order to assure a smooth running of a society there is a need for a strong cooperation between different institutions and also a use of social control to deal with deviant members such as criminals. Additionally, for an efficient functioning of a society, its members need to be healthy; therefore, Parsons defines illness as a form of deviance dysfunctional for the society. This approach fits well with the biomedical model, which pictures diseases and illness as a consequence of certain malfunction in the human body.
The second structuralist theoretical perspective is the conflict Marxist approach, which was first introduced by Karl Marx. The Marxist theory is concerned with the relationship between health and illness and capitalist social organisation. The socio-medical model connects with the conflict theory of Marx as both approaches explain illness and diseases by pointing out inequalities in society as well as disadvantaged life environment (Bilton et al, 2004). Contrasting the functionalist approach, which considers illness as something that occurs almost randomly, the Marxist theory considers levels of illness as a consequence of social class differences. Marx believed that society was divided in two: the bourgeoisie or capitalist social class who was the wealthiest and most powerful and the proletariat who was poorer and whom the bourgeoisie exploited. The name of the conflict Marxism comes from the fact that there is a continual conflict between the two social classes.
How does the two sociological perspectives perceive the role and obligations of health professionals and patients and the relationship between both? What are the criticisms made against these theories?
These two approaches have different views on the role and relationship between the health professional and the patient. They also see the medical profession differently and at different social position.
Firstly, the functionalist approach provides the patient and the doctor with particular terms. The patient is adopting the sick role as he or she presents a number of symptoms that make him vulnerable, which is dysfunctional to the society. Yet, the doctor is the gatekeeper who controls the adoption of the sick role. When a patient is sick he is usually unable to cure himself therefore he would be physically examined by the doctor and consequently be on the sick role. He would also be temporally exempted from his social role. For example, if a housewife is very ill, she would expect her husband or a relative to take over her responsibilities such as cooking or cleaning. But in order to feel better and get back to her tasks, the housewife is ‘obliged’ to seek medical help and also cooperate with the gatekeeper who will allow her to be on the sick role.
However, these assumptions may be criticised and challenged in different ways. Today, as Internet carries an extensive range of information freely available, the patient may be better informed about the symptoms he carries than the doctor he goes to visit. Another criticism of the sick role is its overindulgence, which may lead to malingering. Indeed, this is dysfunctional and can be perceived as avoidance to get back to work. Additionally, the motivation of being cured cannot be valid in each and every circumstance since chronic conditions such as diabetes cannot be cured or prescribed medicines are not taken. Sometimes, the role of patient does not coincide with sickness for example when the patient asks for contraception, being vaccinated or filling in a particular form. Plus the sick role does not address culture, gender, sexuality, ethnicity or class, which can be important factors of having ill health. Furthermore, the role of the doctor is also criticised. Doctors are seen being attracted by the profession only due to the financial reward and their own career interests. Sometimes, doctors may do more harm than good by prescribing treatments making patients dependent and even more ill. Certainly, such a situation would make it more difficult for the patient to complain as sanctions, such as striking a doctor off the medical register, are very rarely used (Moore and al, 2010).
Secondly and contrastingly, the Marxist approach argues that doctors have a false consciousness i.e. doctors belong to the proletariat but the bourgeoisie is exploiting their work by providing them high status and salaries. This makes the doctors contribute to the existent economic inequalities. Doctors are also seen as agents who ensure that people are sent back to work quickly in order to keep working and consequently benefit employers. Indeed, the doctors’ role is keeping a healthy workforce as much as possible. Patients are given medications that contribute to the profit of the drugs industry benefiting the more powerful dominant social classes rather than the patients. Marxists also claim that illness is often linked to stressful and unhealthy environment such as poor working conditions, poverty, poor housing and inequalities in wealth and income (Bilton et al. 2004).
However, critics of the Marxist view focuses on pointing out that doctors’ beneficial work is ignored and also that the doctor work to control the population is completely unrealistic and incorrect. In general, Marxist health care is perceived by politicians as largely ineffective, overly expensive, under-regulated and vastly inequitable.
How does the sociological perspectives perceive the medical professions’ role in socially controlling patients?
Both sociological perspectives of health and illness, either the functionalist or the Marxist theory, exercise ways of socially controlling patients by medical professions.
For Parsons, both the sick role and the medical profession have a prominent part to play in the social control. According to Clarke (2001) the idea behind mechanisms of social control is that they function to maintain the stability and structure of the social system and this by discouraging malingers and promoting conformity to establish norms and social practices.
From the perspective of Marx, health professionals exercise social control by ensuring that the population remains healthy enough to contribute to the economic system as workers and consumers, but is reluctant to offer alternative means for those who do not respond to treatment and are unable to return to work (Lupton, 2011). Indeed, health professionals such as doctors are therefore responsible for maintaining social inequalities i.e. the divide between advantaged and disadvantaged rather than fix them (Lupton, 2011).
Overall, for me it is obvious and clear that the biomedical and socio-medical models are not mutually exclusive. While the socio-medical model brings many benefits to health, especially in the diversity of factors, there are some areas where the benefit of the biomedical model is indispensable. Perhaps the main challenge is how to pick the right theory and use it in the right situation to allow a positive relationship between health professionals and patients. Although the NHS is known to use the biomedical model of health, I believe that using multiple, diverse and approved theories might improve the perception of illness since one perception is not sufficient to approach care. It can also improve the relationship between doctors and patients. The challenge for today’s society is indeed to keep a holistic approach to caring. As an aspiring health professional, it will be interesting to see how these challenges are met in the ground.