In this essay, we will explore the social and medical models, as well as the impact of sociological theory on health and social care delivery. The definition of health is a complex issue, but according to the World Health Organisation, it encompasses more than just absence of illness or disability – it also encompasses overall physical, mental, and social well-being.
(World Health Organisation, 2011). The Social Model of Health and the Medical Model of Health have contrasting perspectives. The Medical Model of Health primarily focuses on individual physical functioning and defines bad health and illness as having a disease.
The text explores two health models: the medical model and the social model. The medical model perceives the body as a machine, with doctors acting as mechanics to address any problems. However, it overlooks the influence of social factors on health and illness. Conversely, the social model concentrates on sociological aspects such as poverty, inadequate housing, and unemployment that can impact health. In the UK, for instance, there exists a significant disparity in life expectancy among various social classes. These research discoveries have sparked disputes within sociology.
Ham (1999) states that there are theorists who argue that they can explain the inequalities in the health service with their proposed theories. One of these theories is the Marxist approach, which focuses on two reasons for the existence of the health service. Firstly, it aims to convince society that our capitalist society cares, thus legitimizing capitalism and minimizing social unrest and class conflict. The second reason is to enable workers to continue working for their employers. When workers become sick, treatment is provided by the health service to restore their health and maintain their productivity as workforce members. This theory can explain why certain segments of society, such as the elderly and those with mental health issues, receive less funding and care since they are considered unproductive members of society and therefore have reduced expenditure.
Despite the NHS embodying socialist principles by offering healthcare to all regardless of income, the pluralist perspective posits that disparities in funding stem from various groups utilizing the health service. According to this viewpoint, multiple competing entities such as doctors specializing in different fields, managers, and politicians contribute to this intricate dynamic instead of a straightforward dichotomy between ruling and working classes.
Alford (1975) proposed that while both theories were beneficial, their combination was even more advantageous. According to him, the health service comprises three distinct factions: the dominant, challenging, and repressed. The dominant group comprises established medical professionals who vie for supremacy, as the winner would wield the most significant authority in decision-making within the other groups. The challenging group includes senior health managers and policy planners. As for the repressed group, it encompasses various patient groups who vie for funding to address their respective conditions.
According to a Marxist perspective, the healthcare system functions by categorizing different groups based on their position in the capitalist social hierarchy. This viewpoint suggests that the health service has two key purposes. Firstly, it acts as a way to legitimize capitalism by portraying it as compassionate, thereby reducing social unrest and class conflicts. Secondly, it ensures that workers can remain productive by offering medical aid when they become sick, enabling them to continue working for their employers. Additionally, this theory explains why certain segments of society, such as the elderly and individuals with mental health issues, receive insufficient funding and care since they contribute less to society and have fewer resources allocated towards their well-being.
The Marxist Theory, also known as Marxism (1895-1900), was developed by Karl Marx and Friedrich Engels. It posits that actions and human institutions are economically determined and emphasizes the class struggle as the main driver of historical change. According to Marxism, communism will ultimately replace capitalism. Economic determinism is a fundamental principle of Marxism, asserting that people’s economic conditions influence political and social structures. Marxism promotes a society without social classes, where all means of production are collectively owned. This outcome is viewed as the unavoidable result of the ongoing struggle between capitalists and workers. As a significant perspective in sociology, Marxism is regarded as one of the prominent theories in the field.
The perspective of structural conflict theory is widely recognized and influential, focusing on conflicts between social groups in society. The social model of health explores how our health and well-being are influenced by society and our environment. It considers factors such as social class, occupation, education, income, poverty, housing, diet, and pollution. Poverty and wealth have significant implications for illness and health, evident in overall life expectancy figures that mask disparities among different social groups within a country (Germov 2005). Unlike functionalism’s belief in a balanced and stable society, conflict theory argues that ongoing struggle and conflict exist among opposing groups in society. Conflict theory has gained popularity since the late 1960s.
The conflict between different groups in society, as demonstrated through civil rights movements and political battles, serves as a significant illustration of the conflict theory. A key figure in this theory is Carl Marx, who emphasizes the ongoing struggle between those who possess resources and those who do not. In a capitalistic society, these groups engage in harmful interactions.
The unbalance in power is caused by the more powerful group exploiting the lower group to gain more power. Conflict theorists perceive society as a battleground where individuals and groups compete for scarce and valuable resources. When observing society, conflict theorists see that individual groups rely on the National Health Service for healthcare, with the majority of people in our society depending on it.
Sociologists have found that inequality exists in the services provided. Research shows that several factors contribute to this, including geographical location determining the level of care received. The allocation of funds to health authorities is often unequal, with specialist teaching hospitals in wealthier areas receiving more funding.
London has consistently received more funding than other regions with comparable requirements due to its numerous prominent hospitals and politicians’ concerns about losing voters if they reduce funding, particularly given its status as the capital city. Additionally, individuals from lower social classes are more inclined to utilize the healthcare system and participate in national screening programs. However, there are obstacles that may hinder their frequent use of healthcare services compared to other social classes. For example, individuals in low-paying and mundane jobs face difficulties in obtaining time off work to access these services, which results in financial losses.
Individuals who lead stressful lives may not immediately recognize the early symptoms of illness as readily as those who are content and in good health. In our society, most people depend on the National Health Service for assistance during times of necessity. Sociologists have conducted research that has revealed disparities in the delivery of healthcare services. Nevertheless, critics of addressing health from a social standpoint have tried to discredit evidence establishing a connection between health and inequality.
The data’s reliability was questioned, specifically in relation to the health selection effect. It was suggested that the direction of causation may not be from society to health, but rather from health to society. For instance, as unemployment rates increase, it is known that the unemployed tend to experience more illness compared to the employed. This raises the question of whether unemployment leads to sickness or if being sick increases the likelihood of unemployment. However, the attempts to address the issue of health selection have been unsuccessful.
The causation from society to health is commonly observed. In 1994, Marmot stated that there is no evidence supporting health selection as the cause for broader social inequalities in health; furthermore, the evidence against this hypothesis has since increased. Critics of the social model of health doubted the reliability and validity of The Black Report’s data. It is important to acknowledge that when attempting to explain class inequalities in health, factors other than health service usage are also significant. As Martini, Allan, Davison, and Backett (1977) and others have demonstrated, disparities in health outcome measures between populations may be more influenced by socio-demographic circumstances rather than the quantity and type of medical care provided.
Nevertheless, addressing any disparity in the accessibility and utilization of health services based on need is an inherent form of social injustice and should be alleviated. This holds true regardless of the proportionate contribution of the health service towards promoting well-being, although the level of prioritization in social policy may depend on the extent of this contribution. Additionally, Cartwright and OBrien (1976) emphasize that one of the key principles behind the establishment of the National Health Service was to dissociate healthcare provision from personal financial circumstances or other unrelated factors (HMSO 1944). Evaluating the extent to which this objective has been accomplished has garnered significant interest. In 1968, Titmuss argued, based on available evidence at that time, that disparities persist in healthcare access, with higher income groups exhibiting a greater ability to optimally utilize the Service and gain access to specialized care, leading them to occupy a larger proportion of hospital beds in better-equipped and adequately staffed facilities (Titmuss, 1968).
In 1969, Rein participated in the American healthcare finance debate and argued that the British Health Service provides fair treatment (Rein, 1969), presenting different evidence. However, Rein assumed that healthcare needs were the same for all social classes and did not consider the connection between utilization and need. Many later studies aim to gain a better understanding of the level of social equality or inequality in the accessibility and use of health services. In Western Europe, capitalism began replacing feudalism during the 16th century, leading to changes in disease patterns.
The industrial revolution in the early 19th century led to major changes, driving the expansion of industrial capitalism. This era was characterized by technological advancements and increased production, resulting in a surplus that enabled societies to undergo the demographic transition. This transition involved shifting from high rates of births and deaths to low rates. In this process, the death rate initially declined more rapidly than the birth rate.
The population underwent a swift expansion until it reached a fresh state of balance. Table 1 showcases the growth of the global population and its estimated equilibrium at approximately nine to ten billion, even though Thomas Malthus raised concerns regarding the population surpassing food supply. In addition, discrepancies are present in the utilization of health services across Spain’s Autonomous Communities, specifically concerning preventive services. Within this context, the working classes encounter notable underutilization due to inadequate provisions within their regions and the expenses (both financial and psychological) linked to accessing these services not being counterbalanced by the disruption caused by illness.
In regard to GP, hospital in-patient, and out-patient attendance, the scenario is unclear and harder to understand due to the unresolved issue of linking utilization to need. Generally, the available evidence indicates that working class individuals utilize GP services more frequently for themselves (excluding their children), compared to middle class individuals. However, the quality of care received by the working class may be inferior. Additionally, it is possible that this higher usage does not entirely reflect the actual disparities in care needed, as evidenced by mortality and morbidity statistics.
The utilization of hospital services, including both in-patient and out-patient services, shows similar increases as occupational class declines. However, there is limited data available and the potential reasons for these observations are complicated. In Britain, there are various forms of inequalities in health services. This report focuses primarily on disparities in health among social (or strictly occupational) classes, as explained in Chapter 1. Table 2 emphasizes these differences.
Comparing the mortality rates of men and women in each of the Registrar Generals 5 classes reveals that the likelihood of dying before retirement is notably higher in class V (unskilled manual workers and their wives) than in class I (professional men and their wives). Both men and women in class V face a mortality risk that is 2.5 times greater than those in class I. Examining age-standardized deaths among individuals aged 15-64, class V males have a ratio slightly less than twice that of class I (OPCS 1978, P37).
2 The disparity in life opportunities between men and women at opposite ends of the job spectrum is not the sole contributor to health inequality. As shown in Table 2, men face a mortality risk that is nearly double that of their wives within each social class. Although the biomedical and social medical models differ in their approaches, assumptions, causes of illness, and interventions, they both offer advantages and have limitations. The biomedical model focuses on individual disease and disability, whereas the social medical model considers the social determinants of health and illness. By incorporating elements of both prevention and treatment, these health models collaborate in addressing various aspects of health. Each model examines health, ideas and assumptions about health, causes of ill health. However, it is important to acknowledge that both the social and medical models have strengths and weaknesses.
The distribution of health or ill-health among populations has long been characterized by concepts of inequality. These concepts extend beyond simple differences; they encompass variations between species, races, sexes, and age groups. The primary focus is not on inherent physiological makeup but rather on socially and economically influenced outcomes. Although seemingly straightforward, the extensive literature and widespread public interest in inequality demonstrate that disentangling man-made factors from the intricate physical and social framework in which humans exist is no simple task.
The notion of permanent and unchangeable differences among individuals is readily embraced. Society’s structures are intricate and exert their impact indirectly and subtly, in addition to being evident and direct. Some individuals view inequality as morally wrong or something that should be avoided. On the other hand, for some, the moral aspect of inequality is negligible or non-existent.
The text argues that differences in wealth and work conditions are a natural outcome of society’s history and suggests that there is limited scope for change. These differences, specifically in terms of health, have often been discussed in relation to inequality and are influenced by man-made factors. It also highlights that the main criticisms of government policies stem from their approach to designing and implementing new policies, rather than the policies themselves, making it difficult to evaluate their effectiveness.
According to one witness, there is a continuous flow of initiatives in the area that is disruptive. These initiatives are not given enough time to establish and function properly. Even when evaluations are conducted, they are often superficial, mainly focused on examining processes and gathering opinions from those involved. Governments frequently rush in with insufficient planning, lacking initial data on the population’s health that will be impacted by the policies. Objectives are not clearly defined, and there are frequent changes to both policies and their objectives. Furthermore, the policies are not maintained for a sufficient period to determine their effectiveness. Consequently, as stated by one witness, significant opportunities for learning have been wasted.
The definition of health tends to diverge between the social and biomedical models, allowing them to cover a wider range of illnesses. There are different ways in which health can be defined. Some argue that being healthy means being free from any disease or abnormality. Others believe that being healthy is dependent on one’s ability to meet the demands of life, as well as factors such as their past experiences, lifecycle, culture, and personal responsibility (White, 2002). These views support both the social and biomedical models of health. The individual has the power to define sickness for themselves. It is a choice whether people perceive themselves as ill or not, and those in positions of power can determine whether someone is classified as ill or not.
In most cases, individuals with power are usually doctors and other medical experts (Browne 1998). According to Kenneth Jones (1991), health and illness cannot be understood in isolation but must be examined within the specific socio-political, cultural, and interactive context. The biomedical model addresses risk behavior and healthy lifestyles, treating individuals as separate from their environment. When comparing the Medical Model and the Social Model of health, the definition of health expands, allowing health theories to investigate broader aspects of illness. This raises the question as to why infant mortality rates are so concerning. Previous analyses suggest that infant death rates are linked to various socio-economic and healthcare system characteristics.
The text highlights a clear association between low infant death rate and per capita GDP. Additionally, there is some evidence suggesting a relationship between infant mortality rankings and income inequalities within society. Therefore, distributional aspects of society and the extent of income inequalities may impact national performance in terms of infant mortality. When it comes to health policy, the provision of nurses, midwives, and hospital beds seems to be more important than the provision of physicians. It is also noted that a focus on preventive antenatal and child health services is necessary within health policy. Considering international comparisons in this matter could have implications for policy decisions.
It is possible that the superior performance of countries like Sweden and Netherlands could be attributed primarily to differences in internal inequalities. For example, if the perinatal mortality rate in England and Wales was the same as that of social classes I and II, or if the infant death rate was the same as that in Oxford RHA, there would be little difference between these countries and ours. The second question is whether the health inequalities between social classes and regions, found in Britain, also exist elsewhere.
The motivating idea behind Marx’s philosophy was materialism, which suggests that the material conditions of the world, such as the structure of the economy and the distribution of wealth, play a significant role in shaping ideas about leadership and deserving earnings.
This idea contradicts idealism, which claims that ideas are responsible for creating material reality. Karl Marx’s idea is focused on exploitation. Marx argued that the true danger of capitalism lies in the exploitation of workers. Marxists have further expanded on his theory to examine how capitalism also exploits the earth and its natural resources. According to Marx, capitalists exploit laborers by paying them less than their value, with the capitalists’ profits coming from the surplus labor of the workers.
This surplus labor is exploited by the capitalist who also forces the laborer into unfitting and unfair working conditions – something that was much more obvious and severe during the 19th century when Marx was writing. Marx’s analysis of history is based on his distinction between the means of production – literally those things, like land and natural resources, and technology, that are necessary for the production of material goods – and the social relations of production, in other words, the social relationships people enter into as they acquire and use the means of production. Together these comprise the mode of production. Marx observed that within any given society, the mode of production changes, and European societies had progressed from a feudal mode of production to a capitalist mode of production. The capitalist mode of production is capable of tremendous growth because the capitalist can, and has an incentive to, reinvest profits in new technologies.
According to Marx, the capitalist class is the most revolutionary in history as it continuously revolutionizes the means of production. Marx asserts that the means of production change at a faster pace than the relations of production. This disparity between the base and superstructure is a significant cause of social disruption and conflict for Marx. The history of the means of production serves as the foundation of history, while everything else, including ideological debates pertaining to this history, forms the superstructure.
Karl Marx developed his philosophical idea of history by investigating and examining the various means of production, including land, raw materials, and factories, which serve as the foundation for the creation of materialistic goods. Through his research, Marx discovered that European societies had transitioned from a feudal system of production to a capitalist society. The constant fight against oppressive cultural norms and dominant social relations has been present throughout human history. Hence, the key challenge in conflict resolution research is to determine the origins of the dominant structure that gives rise to conflicts.
This course examines the underlying factors behind environmental conflict, labor disputes, issues in urban communities, and violent culture within modern society. It acknowledges the historical presence of oppressive cultural norms and the ongoing struggles against dominant social relations. Researchers in this field seek to understand the origins of the dominant structure that leads to conflicts. In recent studies on health inequalities in Britain, there has been a focus on the widening health gap.
This study demonstrates how the gap in health inequalities in the United Kingdom could be reduced if certain social policies implemented by the Government are effective. The research, conducted by Dr Richard Mitchell and Professor Daniel Dorling from the University of Leeds, and Dr Mary Shaw from the University of Bristol, analyzed every parliamentary constituency in Britain and simulated various social policy scenarios using statistical techniques. The findings imply that if key social policies are successful, the widening health gap caused by social inequality can be narrowed. It is important to note that the essence of capitalism lies in economic freedom.
Practices such as ill-conceived subprime lending and crippling corporate fraud are consequences of a system that centers around individuals’ rights to pursue their financial goals without government intervention. Adam Smith, a key early thinker of capitalism and a Scottish political economist, may have advocated for separating economics from politics in its best interest. Nevertheless, economics is inseparable from notions about individuals’ roles in society, making it heavily related to politics (as evident from the global outcry against capitalism, with shouts of “Die capitalist pigs” echoing around the world). Economic freedom stands as the central principle of capitalism.
The system that allows individuals to pursue their financial goals without government intervention has several negative consequences, including poorly-conceived lending and disabling corporate fraud.
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