The biomedical model of health and illness

The biomedical model, widely supported by scientists and healthcare professionals, views health and illness as conditions determined by physical and biological factors within the body. This perspective focuses on the body as a system that can be repaired when it malfunctions, much like a machine.

Core principles of the biomedical model

• Absence of abnormality - Health is defined as the lack of any biological irregularities or diseases in the body.
• Mechanical analogy - The human body is compared to a machine that requires fixing through medical interventions when it breaks down.
• Dependence on medical knowledge - The overall health of a society is seen as reliant on advancements and expertise in medical science.

Biomedical view of disability

• Focus on the individual - This model concentrates on the patient, aiming to address and correct disabilities through medical treatments and interventions.
• Interventionist approach - Medical practices such as surgery, physiotherapy, and the use of equipment like braces or wheelchairs are employed to manage or 'fix' the disability.

Criticisms of the biomedical model

The biomedical model, while dominant in medical practice, has faced significant critique from sociologists and other scholars who argue it overlooks broader social and environmental influences on health and disability.

Key criticisms of the biomedical approach

• Historical improvements - Sociologists like McKeown (1976) argue that better nutrition and hygiene, especially through public health reforms in the 19th and 20th centuries, have contributed more to health improvements than medical advancements.
• Social causes ignored - Marxist sociologists in the 1970s suggested that this model diverts attention from social determinants of illness, such as poverty or working conditions.
• Stigmatisation of illness - The approach can label individuals with illnesses or disabilities as abnormal, implying a need to be 'fixed' rather than accepted.
• Individualisation of disability - Tom Shakespeare (2000) criticised the model for focusing on individual symptoms rather than addressing wider social barriers faced by disabled individuals.
• Creation of illness - Ivan Illich (1975) and others have claimed that modern medicine itself can generate health issues through over-intervention.

Illich's perspective on iatrogenesis and medicalisation

Ivan Illich, a prominent critic of modern medicine, offered a radical view on how the medical profession can harm health by overstepping its role and undermining natural human resilience.

Illich's definition of health

• Coping with reality - Illich (1975) defines health as the ability to deal with the inevitable realities of death, pain, and sickness, contrasting sharply with the biomedical focus on eliminating these experiences.
• Critique of medical overreach - He argues that the medical elite, primarily doctors, attempt to control these natural aspects of life, turning individuals into passive consumers or objects rather than active participants in their health.

Types of iatrogenesis according to Illich

• Clinical iatrogenesis - Harm caused by medical errors, ineffective or unsafe treatments, or incorrect diagnoses that negatively impact patients.
• Social iatrogenesis - The loss of personal control over health as more life aspects are medicalised, meaning everyday issues are treated as medical conditions requiring professional intervention.
• Cultural iatrogenesis - The erosion of traditional methods and cultural understandings of handling death, pain, and illness, replaced by a medical framework.

Medicalisation and cultural impact

• Medicalisation of life - This refers to the process where normal human conditions or behaviours are redefined as medical issues to be diagnosed and treated.
• Death as taboo - Illich suggests that death has become an ultimate act of resistance against consumerism, as society no longer views it as a natural part of life but as something to be fought against at all costs.

The social model of health and illness

In contrast to the biomedical model, the social model, often favoured by sociologists, considers health and illness as outcomes shaped by external social and environmental factors rather than purely physical ones.

Fundamental ideas of the social model

• External influences - Health and illness are seen as results of societal conditions like diet, housing, and stress, rather than just internal biological factors.
• Historical context of medical dominance - The control of health definitions by medical professionals is a relatively recent development; for instance, in the 1700s, mental illness was often attributed to spiritual causes rather than medical ones.
• Social constructs - Definitions of what constitutes health or illness are viewed as ideas created by society, not always tied to objective physical symptoms but influenced by cultural values.
• Diagnosis dependency - An illness is often only acknowledged as legitimate in modern society if certified by medical professionals.

Social view of disability

• Outward focus - This model looks beyond the individual to identify environmental and social barriers, such as lack of accessibility or equal opportunities, that contribute to disability.
• Example of barriers - A person using a wheelchair might be more hindered by the absence of ramps or accessible facilities than by their physical impairment itself.

Criticisms of the social model

While the social model provides a broader perspective on health and disability, it is not without its detractors who highlight limitations in its approach to certain undeniable physical realities.

Key limitations of the social model

• Objective nature of illness - Some conditions, like food poisoning, are not subjective and remain unaffected by social or environmental changes, challenging the model's emphasis on social construction.
• Ignoring physical impairments - In the context of disability, the model often overlooks the real pain or limitations caused by physical impairments, focusing instead on societal barriers.

Distinction between impairment and disability

• Impairment - A specific physical or mental condition, such as blindness or loss of limb function.
• Disability - The societal failure to accommodate such impairments, like not providing accessible cash machines for visually impaired individuals, which prevents full participation in everyday activities.

The concept of the body as a social construction

The perception of the body, including its ideal form and typical characteristics, is heavily influenced by societal norms and cultural attitudes rather than being solely a biological entity.

Social influences on body perception

• Ideal body shape - Cultural ideals of body size and shape vary over time; for example, modern media often promote a slim figure for women and a muscular build for men, whereas historically, a fuller figure signified wealth and health.
• Cultural lifestyle impacts - Dominant societal attitudes towards diet and lifestyle affect typical body shapes, as seen in the link between fast food culture and rising obesity rates in some countries.
• Objective health risks - Despite social constructions, certain physical traits, such as a high body mass index (BMI), are scientifically associated with increased risks of various health conditions, grounding some aspects of body perception in biological reality.