Social and Medical Models of Health

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It can be suggested that improvements in health are as a result of the technological advancements which have been made in medical science. The medical approach of health focuses predominately on the eradication of illness through systematic diagnosis and effective treatment programmes. In contrast, the social model of health place an emphasis on the changes that need to be made by society, empowering people to be responsible for their own health and lifestyles, in order to make the population healthier.

Currently there are vast debates regarding the future of health and social care across the United Kingdom (UK), and the terms social and medical models are emerging themes. For the purpose of this assignment the author will compare and contrast the medical and social models of health in chronic disease and disability, underpinning theory and practice. A model can be defined as ‘representing a particular type of theory, namely structural, which seeks to explain phenomena by reference to an abstract system and mechanism.

Models of disability are not synonymous with theory as their usage does not involve data collection, but they may have some usage as generators of hypotheses. It is important to remember that models may help to generate an explanation in some way, but they do not themselves constitute an explanation. ‘ (Llewellyn and Hogan, 2000) It can be considered that medical and social models are widely discussed within disability rights. The social model would appear to be based on the premise that people are not disabled due to illness or impairment; instead, that they are disabled because of how society is constructed.

However, the medical model would oppose this, viewing the person’s impairment as the cause of the disability thus the owness is on the person with the disability to adapt within society, instead of society adapting to them. In order to understand this fully we need to question whether the focus should be on the individual or on the wider social context. It is perhaps within these terms that we should try and understand the differences between the social and medical models of health.

Historically the disabled and the chronically sick were institutionalised and perceived by society as some form of ‘freak’, or that the person was being punished by god in some way. The families of disabled people were traditionally mocked by society, and they felt compelled to ‘hide’ the disabled person away. Unfortunately society as a whole permitted this to happen. The individual medical model of disability tends to regard disability as a personal tragedy, that has befallen the individual and therefore a cure is sought (Oliver 1996).

This places the individual with the impairment to a ‘sick role’ whereby others make decisions about the quality of that person’s life (Pfeiffer, 1998). The sick role can be defined as: (judged by a doctor) gives permission not to be coping. When we are sick or in poor health we are generally expected to behave in a specific way or conform to what is considered as the ‘norm’ for being sick, for example, taking to our bed, keeping warm and ‘staying in our pyjamas’.

By definition a medical model of disability or chronic illness is identified as a disability that derives from a disease, some form of trauma or a health condition that disputes physiological or cognitive function. Therefore, the medical emphasis is that of treatment, cure and prevention, whereas, the World Health Organisation (WHO) defines disability and impairment as; ‘Disability in the context of the health experience is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being impairment.

In the context of health experience, impairment is any loss or abnormality of psychological, physiological or anatomical structure or function. ‘ (WHO, 1980). Throughout our lives, predominantly we should have the benefit of good health; it is only when we become ill that our everyday routines or normalities become disrupted.

Within contemporary society, perhaps one of the most common causes of ill health is that of the common cold or flu virus, which may contribute to a reduced independence for a short period of time. It has been suggested that ‘In Western society chronic conditions are becoming increasingly common, in fact most of the population will at some point in their lives know someone who has or is suffering from some form of chronic illness and will be aware of the implications of such a condition. ‘ (Jones and Moon, 1987)

However, having a disability or chronic illness, for example; multiple sclerosis, parkinson’s disease, heart disease or chronic obstructive pulmonary disease (COPD) reduces a persons independence immensely; not only in the work place, also within society as a whole. An example of this is of a fifteen year old boy who was diagnosed with multiple sclerosis several years ago. The medical model is to ensure that he is as medically well as possible, and that his illness is supported by a controlled and structured programme of oral and injected medication.

The medical view also promotes prevention of further ill health by ensuring this young boy is vaccinated against potential seasonal illnesses. Whereas the social model perceives this boy as obese, lethargic, stupid and lazy; society are unable to identify with the holistic (whole) approach of his illness, as he displays (apart from obesity through large doses of steroids) no physical attributes of a perceived disabled person.

Medics can occasionally appear to have a rather patronising view of disabilities and can also generalise or stereotype, for example: A disabled person keeps having repeated headaches, after a consultation, it can be deduced by the medic that these are all part of the illness or disability which they have, and a prescription is issued to repair that temporary condition with some form of medication. In essence, the body is a machine and can be repaired or treated.

It can be suggested that medics occasionally do not fully understand the holistic approach of often exceptionally complex situations that will occur with disabled people, and therefore have a propensity to try and placate them with ‘a pill’ (Pfeiffer, 1998). Jones, (1987) further suggests that medics often make decisions for the disabled or chronically ill person; medics are in a position of empowerment to determine for example; where a person should live, their education and potential working capabilities.

The problems and issues of disability or chronic illness lie not with the individual impairment, however, with that of the hostile social environment that we inhabit. This is particularly prevalent in education, employment, social and health care, the physical environment and the denial of emotional rights, for example sexuality, relationships and parenthood. It could be questioned that should a disabled woman have the right to have children? What are the probabilities of her disease being genetically inherited?

If the person is disabled and unable to care for themselves independently, what is the likelihood of them being able to care for a child as well? It could be considered whether the type of behaviour displayed by our society is diverse and equitable. Why should somebody be denied the possibility of motherhood, because of societies beliefs; is there any evidence that suggests disabled or chronically sick people would make lesser parents than an able bodied person, remembering that even though they are disabled or chronically sick they also still have feelings, emotions and basic human needs?

The social model of disability, which was developed in the mid 70’s, emerged from a publication called the Fundamental Principles of Disability, published by the union of the physically impaired against segregation (UPIAS). The document stated: ‘In our view it is society which disables physically impaired people. Disability is something imposed onto our impairments by the way that we are unnecessarily isolated and excluded from full participation in society (UPIAS, 1976).

In essence this does not deny the problem or barriers faced by disabled people; however, it places the responsibilities of those problems within society rather than the individual. Hence the social model of disability is displaced from the victim blaming medical model, suggesting that disability is a form of social oppression. ‘Dependency is created amongst disabled people, not because of the effects of functional limitations on their capabilities for self care, because their lives are shaped by a variety of economic, political and social forces which produce it’ (Oliver, 1990).

However, the social model of health in disability and chronic illness is not free from criticism as Marks, (1999) summarises the limitations of the social and medical models of disability by identifying that, it tends to ignore the differences experienced of disability as a result of gender, sexuality, race, and culture. Whilst society acknowledges that there are disabled people living within our community, only a small proportion of local and national government funding is directed into supporting disabled people, disability should not be ignored.

Perhaps there has been a change in society’s attitudes; evidence suggests that more chronically sick people are being cared for at home with their families, (National Health Service NHS, 2007). More people have daily support from social services, and the NHS suggests that there is a reduction in people who are disabled or chronically sick spending extended time in a hospital environment. Society prioritises acute diseases, for example, cancer. By being given a diagnosis of cancer, the society in which we live, perceives that these people should take precedence over the people who have long term chronic diseases.

For example, vast amounts of research over the past decade have been infiltrated into the prevention, treatment, cure and palliative care of cancer, whereas little funding or priority has been given to the disabled and chronically sick, in particular into research about possible treatments and cures. Cancer reinforces the medical model, in essence the more intervention from the medics the more it is seen as a medical problem, whereas society views disability negatively preferring to ‘wrap the person up in cotton wool’ to prevent further injury.

To be successful the author recommends that research needs to be led by disabled activists to be successful. To conclude, whilst we live in the 21st Century and medical intervention has superseded all expectations, for example in the research of cancer; routine well person checks, cholesterol checks, vaccinations and the general prevention of ill health to ensure that society remains well. However, it can be deduced by the author that both the medical and social models of health may perhaps be perceived as somewhat archaic in today’s contemporary society.

General Practioners and Consultants are principally driven by Government set targets, the whole person or the holistic view of care rarely enters into the equation. Health to doctors is financially and economically driven, in essence ‘a business venture’. In contrast the social model depicts some substantial changes and improvements over the last decade; however, there still is a considerable amount of social ignorance.

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