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Models of Health:
Competing or Complementary?
Module 1
Introduction
Lecture Outline
The Biomedical Model of Health
The Social Model of Health
Social Determinants of Health
The Social Gradient of Health
Health Inequality and Health Equity
The Sustainable Development Goals
The Sociological Imagination
Analytical Tools
The Sociological Imagination Template
The Structure-Agency Debate
Thesis
The Biomedical and Social Models
of Health are complementary, not
competing, because they focus on
different aspects of health and
illness. We need both models to
effectively cure individuals
(Biomedicine), and to promote
the conditions for healthy living
(Social Model of Health) for
individuals, families, communities,
countries and the global
population.
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TEXT

What is the Biomedical Model of Health?

The Biomedical Model of Health, or
‘Biomedicine’ is:
“The conventional approach to medicine in
Western societies, based on the diagnosis
and explanation of illness as a malfunction
of the body’s biological mechanisms. This
Biomedical Health professionals:
approach underpins most health doctors, specialists, nurses
professions and health services, which Allied health professionals: OT
focus on treating individuals, and generally Institutions: hospitals, clinics
ignores the social origins of illness and its Medical screening and imaging: blood,
prevention.” x-ray, MRI
Pharmaceutical drugs: antibiotics
(Broom & Germov, 2014, p. 11) Emergency services: paramedics,
ambulances

TEXT
Characteristics of Biomedicine
BIOMEDICAL MODEL
Focus  individual focus: acute treatment of ill individuals
 clinical services, health education, immunization

Assumptions  Health and illness are objective biological states

 Individual responsibility for health
Key indicators  Individual pathology
of illness  Hereditary factors, sex, age
 Risk-taking factors
Causes of  Gene defects and micro-organisms (viruses,
bacteria)
So, as a healing modality,
illness
 Trauma (accidents) Biomedicine’s focus is on the
 Behavior/lifestyle curing or treatment of the
Interventions  Cure individuals via surgery and pharmaceuticals individual physical body, via
 Behavioural modification (non-smoking, exercise, surgery, pharmaceuticals or
diet) behaviour modification
 Health education and immunisation
Goals  Cure disease, limit disability and reduce risk
factors to prevent disease in individuals
Benefits  Addresses disease and disability in individuals
Criticisms  Disease focus leads to lack of preventive efforts
 Reductionist: ignores the complexity of health
and illness
 Fails to take into account social origins of health
and illness
 Medical opinions can reinforce victim-blaming
(Germov, 2014, p. 17)
(Human Anatomy, 2015)

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TEXT
The Culture of Biomedicine
(300 BCE -1800s)

• Draws on early thought – Plato, Socrates

• Became an organised healing system in the
17th century Descartes
(1590-1650)
• René Descartes is seen as a key thinker in
the early cultural establishment of
biomedicine – from his name we get
Cartesian Dualism
• Cartesian Dualism: “a belief that the
mind and body are separate entities. This
assumption underpins medical approaches
that view disease in physical terms and
thus ignore the psychological and
subjective aspects of illness” (Germov, 2014, p. 12)
• The result is seeing the ‘Body as a Machine’

WEB LINK
This short video provides an amusing look at Biomedicine:
http://www.youtube.com/watch?v=2IOrQwLs420&feature=related

TEXT
Epidemiology (1850s)
The Broad St.
pump and
“John Snow (1813–1858) is an iconic figure in public map of
health – the forefather of epidemiology, the man who individual
first proved cholera was water-borne by tracking an cases across
outbreak to a water pump in Soho, and a pioneer in Soho, London
anaesthesia who attended to Queen Victoria during
labour.” (LSE, 2013)

This was the start of the Social Model of Health!

Epidemiology: “The statistical study of patterns of

disease in the population. Originally focused on
John Snow
epidemics, or infectious diseases, it now covers non-
infectious conditions such as stroke and cancer”

Over time, patterns of disease across population have

revealed a trend: Epidemiological Transition: “a change
in disease patterning in countries from infectious
diseases to chronic ‘lifestyle’ diseases” (Germov, 2014, p. 9)
Follow this link to a short video about John Snow and the start of the Social Model of
Health: http://www.youtube.com/watch?v=XCQbi8zzrkc
WEB LINK (LSH & TM, 2013)

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The World Health Organisation’s

definition of health (1946)

Health: There is no definite meaning of health. Its meaning can be different

depending on individuals, social groups and cultures, and can differ at different
times.

“a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity” (WHO, 1946)

• WHO focuses on the causes of the causes of health and illness.

• The WHO definition is holistic; it moves beyond physical and includes

mental and psychosocial health as well as social context

TEXT

What are Human Rights?

Human Rights: Rights held to be justifiably belonging to any person

Said to be:
• Due to our ‘humanness’
• universal (all humans have them)
• Inalienable (cannot be taken away)

Is a moral or legal claim

Is a relationship: if an individual or group claims a HR, another individual or group
needs to uphold or protect that HR

Who makes
“I have sure that
a right right is
to X” protected?

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Universal Declaration of
Human Rights (1948)
Post WW II was a major era for
human rights
Universal Declaration of
Human Rights (1948)
• United Nations
• First global expression of
human rights
• 30 articles that were the
start of many human rights
instruments
• This was a major moment of
cultural and political change
in the world
Characteristics
of the Social
Model of Health
This is a snapshot of a Google search on
the Social Model of Health.
Images of the Social Model of Health
situate individual health and illness within
the broader context – family, community,
society
In your degree, you will encounter
different tools to analyse health in
context.
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TEXT
UDHR, Article 25
”Everyone has the right to a standard of
living adequate for the health and well-
being of himself and of his family, including
food, clothing, housing and medical care
and necessary social services
... and the right to security in the event of
unemployment, sickness, disability,
widowhood, old age or other lack of
livelihood in circumstances beyond his
control.”
TEXT
SOCIAL MODEL
Focus  societal focus: living and working conditions that
affect health
 public health infrastructure and legislation, social
Assumptions 

services, community action, equity/access issues
Health and illness are social constructions
Social responsibility for health
Key indicators  Social inequality
of illness  Social groups: class, gender, ‘race’, ethnicity, age,
occupation, unemployment
 Risk-imposing factors
Causes of  Political/economic factors: distribution of
wealth/income/power, level of social services
illness
 Employment factors: employment and educational
opportunities, stressful and dangerous work
 Cultural and structural factors
Interventions  Public policy
 State intervention to alleviate health and social
inequalities
 Community participation, advocacy, and political
lobbying
 Prevent illness and reduce health inequalities to aim
Goals
for an equality of health outcomes
Benefits  Addresses the social determinants of health and
illness
Criticisms  Utopian goal of equality leads to unfeasible
prescriptions for social change
 Overemphasis on the harmful side effects of
biomedicine
 Proposed solutions can be complex and difficult to
implement in the short-term
 Sociological opinions can underestimate individual
responsibility and psychological factors
(Germov, 2014, p. 17)
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TEXT
What the Social Model of Health
contributes to health knowledge
The Social Model of Health clarifies

1. The social production and distribution of health and illness: “Different

levels of access to the social determinants of health result in observable
patterns of disease” (epidemiology)

2. The social construction of health and illness: “How definitions of health

and illness can vary between cultures and change over time”

3. The social organisation of health care: “The way a particular society

organises, funds, and utilises its health services”

NOTE: the Social Model of Health is not a healing modality like Biomedicine;
clinical services are not provided. Its interventions are in the areas of social
determinants of health, policy change and community engagement.

TEXT

The Social Determinants of Health

“The social determinants of health (SDH) are the conditions in

which people are born, grow, work, live, and age, and the
wider set of forces and systems shaping the conditions of daily
life. These forces and systems include economic policies and
systems, development agendas, social norms, social policies
and political systems.” (WHO, 2015)

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Transportation Housing

(Marc F, 2012) (Habitat for Humanity, nd)

Public health infrastructure: “The buildings, installations and

equipment necessary to ensure healthy living conditions for the population”
• particularly WASH (water, sanitation and hygiene)

Some 3.4 million people die each year from water,

(Water Sanitation and Hygiene Org, 2016).
sanitation and hygiene-related causes. (IPS, 2012)

Income inequality = health inequality

The Champagne-glass depicts
Socio-economic status (SES): “A the uneven distribution of wealth
statistical measure of relative inequality across a society. Health outcomes
that classifies individuals, households, or for people in the richest 20% are far
better than those in the poorest
families into one of three categories –
20%
low SES, middle SES, or high SES –
derived from a combination of income,
occupation, and education.”

Health inequality: “Different health

status associated with various social
groups, gender, age, ethnicity”

Health inequality is directly related to

income inequality

(PovertyEducationOrg, nd)

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The Social Gradient of Health

The Social Gradient of Health: “A continuum of health inequality in most
countries from high to low, where the poorest group of people have the worst health
status, and each group above it has progressively better health, with the most socio-
economically advantaged group having the best health status.”

Whitehall Studies – 2 longitudinal studies of

British civil servants, which found:
• Health inequalities exist not just between the
wealthy and the poor, but between each
grade of the employment hierarchy Health
• Indicators – e.g. measures of coronary heart
disease, self-reported illness, sickness days
• Therefore, one’s position in the social
hierarchy affects one’s health
• Factors: amount of control over work, how
much skills are used, challenge/monotony

(Marmot & Wilkinson, 2006) Socio-Economic Status

Health Inequality
Life Expectancy (LE) data show health inequalities both within
countries, and between countries

Indigenous and non-

High and low-income countries
Indigenous Australians

(AIHW, 2012, p. 87)

Indigenous Australians have lower LE Low-income countries have lower LE

than non-Indigenous Australians than high-income countries

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TEXT

Health Equity: “Is this fair?”

Equality and inequality are descriptive terms
to refer to greater or lesser levels of access to
the social determinants of health.

In health equity, we move beyond description

to judgement – are these differences are fair,
or unfair?

Equity: “Fairness, the application of the

principles of justice to correct or supplement
rules of law.”

Does everyone have

Health equity: The “absence of avoidable
differences.” In other words, where possible,
doing what we can to alleviate inequalities to
make things more fair.
EQUAL OPPORTUNITY
to be optimally healthy?
Sometimes, people need help in
order to participate equally.

Addressing Global Health Inequalities

The Millennium Development Goals
MDGs were successful because:
• A clear agenda
• 8 goals set by the United Nations in
the year 2000 (the Millennium) • Moral, rather than legal, initiative
• Finished in 2015 • Measureable outcomes
• Focus was on low-income countries • United, global agenda
• Health was central to all 8 goals
• The MDGs required countries to
work on the Social Determinants of
Health
• Massive progress was made,
particularly in terms of HIV/AIDS,
Follow this link to view a short video about the
child mortality and maternal health Millennium Development Goals:
http://www.youtube.com/watch?v=v3p2VLTowAA
WEB LINK

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Moving from the MDGs to

Sustainable Development Goals
• From 2015, we have a
new global agenda
• 17 goals for all
countries
• Environmental
sustainability underpins
all goals
• Each goal has
measurable targets

(United Nations, 2015)

Follow this link for a UN video on the transition from MDGs to SDGs)
WEB LINK https://www.youtube.com/watch?v=k4FAiI2mdaI

TEXT
Changing the way we think:
The Sociological Imagination
C. Wright Mills, an American sociologist – defined the
Sociological Imagination as:

“the vivid awareness of the relationship between

private experience and the wider world”

“A sociological imagination gives us a window into

various social forces and the way they influence people’s
lives and makes a link between personal troubles and “A digital painting exploring the powers of
public issues” (Germov, 2014) a child's imagination” (Auclair, 2015).

Personal trouble: a person’s father is diagnosed with diabetes, resulting in stress and
change in the home environment
Public issue: in Australia, diabetes is said to be reaching epidemic proportions, and affects
both children and adults

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TEXT
Tool:
The Sociological Imagination Template

Willis (2004) suggests that the Sociological Imagination consists

of 4 interrelated parts:

1. Historical factors – how the past influences the present

2. Cultural factors – how our culture impacts upon our lives

3. Structural factors – how particular forms of social

organisation shape our lives

4. Critical factors – how we can improve on what exists

THE SOCIOLOGICAL IMAGINATION TEMPLATE

HISTORICAL This asks us to consider events that led to today’s situation. For countries, this could be war or conflict,
FACTORS corruption, governance, major changes in cultural and structural factors. For individuals, events in one’s
life history led to the problem of interest.
CULTURAL Culture is “a system of shared ideas, attitudes and practices” (Fanany, 2009, p. 24)
FACTORS Culture is a ‘lens’ with which we view the world and use to make sense of it (Helman, 2007, p. 3)
We create or, in other words, we socially construct meaning because our views are always shaped by our
cultural background and the social context in which we live.
Culture: a) changes over time; b) interacts with biology and the environment; c) is affected by and affects
structural factors (e.g. age, gender, ethnicity); d) is understood and expressed differently by
members of a cultural group The Sociological
Both ideology (how we think) and material (what we create and use)
Culture shapes our values, attitudes, beliefs and norms Imagination
Ways of understanding our ‘lived experience’
A set of guidelines for behavior, inherited and learned
Template is a way
Belief systems, including secular, spiritual or religious, that give meaning to life to group social
Belief systems about the design and function of the human body, health and illness, healing
Practices – food, clothing, body adornment and modification, marriage, sickness, birth and death determinants of
management
health.
STRUCTURAL Government Laws, policies and law Transport Age
FACTORS Economy enforcement Public health Gender We do this so we
Employment Family structure - infrastructure (WASH) Social hierarchy – SES,
Education tribe/clan/mob Ethnicity caste
can see an issue
Rural/urban Media Religion Housing comprehensively,
Built environment Land War and conflict Racism
Food and water systems Health Care analyse what is
CRITICAL Success Story: example when an intervention in the past resulted in improved health outcomes happening in
Summary: What has been described
FACTORS
Implications for Professional Practice
context, and
1. The social production and distribution of health and illness design good
2. The social construction of health and illness
3. The social organization of health care
interventions
Predictions: If things remain as they are, what do you predict will happen to your health issue in the near
future?
Recommendations: What recommendations could be made? In an ideal scenario, what should happen?
What realistic interventions could be undertaken?
Conclusions that can be drawn

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Brief Example of the SI Template

If we were conducting an analysis of HIV/AIDs using the SI Template, some
questions we could ask include:

1. Historical factors – When did HIV/AIDS arise here? How did people respond?
(governments, community organisations, individuals). How has the disease
pattern changed over time?

2. Cultural factors – Are there local beliefs about the cause of HIV/AIDS? Do
local norms allow for condom use? How do people view biomedicine?

3. Structural factors – How do various social institutions such as family or

gender impact HIV transmission, and access to screening and antiretroviral
medication?

4. Critical factors – What do we need to do to reduce new cases of HIV and to

effectively treat those living with HIV/AIDS?

Discussion – the SI Template

• The SI Template is a tool for analysing complex health issues
• It draws connections between various social determinants of health
by grouping them into historical, structural and cultural factors
• Is not used for clinical assessment (too time-consuming) but informs
health practice:
• Understand the multitude of factors affecting any one person (both
the health professional and patient/client)
• Helps to reduce assumptions, undermines stereotypes, and
therefore improves cultural safety
• Draws attention to power relationships within society and within
health systems
• Useful for planning broad health interventions and prevention

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TEXT

Tool: The Structure-Agency Debate

agency structure

Agency: “The ability of people, individually and collectively, to influence their own
lives and the society in which they live”

Social structure: “The recurring patterns of social interaction through which people
are related to each other, such as social institutions and social groups”

Structure-agency debate: “A key debate in sociology over the extent to which

human behaviour is determined by social structure”
(Germov, 2014, p. 9)

Summary
Biomedicine is the conventional healing system in ‘Western’ countries and focuses on
individual pathology. The Social Model of Health (SMH) arose historically in response to a
cholera epidemic in 1850s’ London. The SMH became increasingly important internationally
with the World Health Organisation’s holistic definition of health (1946), the Universal
Declaration of Human Rights (1948), the Millennium Development Goals (2000 – 2015) and
now the Sustainable Development Goals
The ‘epidemiological transition’ refers to a change in disease patterning in a country from
infectious to chronic or lifestyle diseases, although many countries today have a ‘double
burden’ of both infectious and lifestyle diseases
The SMH recognises that health is affected by the social determinants of health, and that it is
our collective responsibility to alleviate health inequalities, prevent illness and promote health.
Social determinants of health directly impact health, as seen by the social gradient of health
and differences in Life Expectancy.
Health inequalities are to some extent inevitable and unavoidable, but ‘health equity’ reminds
us that we can put policies in place to reduce these inequalities. This requires us to look at
political, social and economic power. Globally, health inequalities are addressed through the
Sustainable Development Goals
The Sociological Imagination is a ‘quality of mind’ that helps you to understand both personal
health issues and the wider social context in which they are situated. The Sociological
Imagination Template is a tool to group and analyse the specific Social Determinants of Health
impacting a health problem. The Structure-Agency debate helps us to consider individual
action within its social context.

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Implications for Professional Practice
• We will see the implications of
these key terms for health
outcomes throughout this unit
• Biomedicine is the healing system in
which you are being trained, will
work, and will seek health care
• You need to know Biomedicine’s
history, underlining thinking and
culture
• The Social Model of Health is
relevant to all health professions
and is the focus of this unit
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Conclusion
The Biomedical and Social
Models of Health are
complementary, not competing.
We need both to effectively cure
individuals (Biomedical Model of
Health), and to promote health
and wellbeing of individuals,
families, communities, countries
and the global population (Social
Model of Health).
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