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Medical and Social Model of Health

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    In this essay, the terms social model and medical model will be explored. Then, aspects of sociological theory and how it influences the delivery of health and social care will be explored Health is difficult to define but fairly easy to spot when we actually see it. According to the World Health Organisation Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

    (World Health Organisation, 2011). There are two main models of health which reflect very different perspectives. These models are known as Social Model of Health and the Medical Model of Health.In the medical model of health, the main attention focused on individual physical functioning and defines bad health and illness as the presence of disease.

    This model is dominated by views and opinions of genetically determined disease and biological status. The medical model views the body similarity to a machine, in which case, if the body was to break down a doctor would take role as a mechanic and attempt to fix body (Ken Browne, 2002) Unlike the social model, the medical model of health does not take into account social attributes which can also have an effect on health and illness.The social model of health tends to focus on sociological factors linking to illness such as poverty, poor housing and unemployment. For instance, the impact that poverty and social class has on illness and health are reflected in life expectancy figures (UK National Statistics, 2009) Although life expectance in the UK has risen, there is still a significant gap in life expectancy between the middle class and the working class ( Office for National Statistics, 2011) Research with such results has been a controversial sociological topic for a while.

    There are theorists that believe that the inequalities in the health service can be explained by their theories, Ham (1999) has suggested three theories that can be looked at for this. The Marxist approach looks at the two reasons they believe the health service exists, firstly it persuades society that our capitalist society cares, it legitimises capitalism by limiting social unrest and class conflict. The second reason, is that is enables the workers to carry on working for the bosses, as when they are ill the health service makes them better and allows them to carry on being a productive member of the workforce.This theory would explain why certain members of society such as the elderly and those with mental health problems receive less funding and care, they are not productive members of society therefore receive less expenditure.

    Though the fact that we do not directly pay for the National Health Service and that all members of society can access it, irrespective of their income is a socialist principle and not a capitalist one. The pluralist approach believes that the is the power of the groups that use the health service, that cause the inequalities in funding.They believe there are numerous groups that all compete against each other, and it is more complex that just the ruling class against the working class division. This would explain the conflict between the groups of doctors from various fields that compete for funding for their speciality, managers and politicians.

    Alford (1975) suggested that both these theories were useful, but combining them was more useful. He believes there are three parties in the health service, the dominant, challenging and repressed.The dominant group consists of established medical professions who compete for dominance, the winner will have the greatest power to make decisions over the other groups. The challenging group, consists of senior health managers and policy planners, the third group is the repressed who are different groups of patients who compete for their conditions to be funded.

    He believes that the groups within the health service, are grouped according to their power and that the higher groups have more power due to social hierarchy, as seen in the rest of the capitalist society.The Marxist approach looks at the two reasons they believe the health service exists, firstly it persuades society that our capitalist society cares, it legitimises capitalism by limiting social unrest and class conflict. The second reason, is that is enables the workers to carry on working for the bosses, as when they are ill the health service makes them better and allows them to carry on being a productive member of the workforce.This theory would explain why certain members of society such as the elderly and those with mental health problems receive less funding and care, they are not productive members of society therefore receive less expenditure.

    The Marxist Theory Views Marxism (18951900) is the economic and political theory and practice originated by Karl Marx and Friedrich Engels that holds that actions and human institutions are economically determined, that the class struggle is the basic agency of historical change, and that capitalism will ultimately be superseded by communism.They include the notion of economic determinism that political and social structures are determined by the economic conditions of people. Marxism calls for a classless society where all means of production are commonly owned, a system to be reached as an inevitable result of the struggle between capitalists and workers. Marxism is a key sociological perspective and is referred to as one of Sociologys grand theories.

    It is a structural theory and is the most influential and widely known version of conflict theory, focusing on the conflicts of social groups within societyThe social model of health looks at how society and our environment affect our everyday health and well-being, and includes factors such as social class, occupation, education, income and poverty, poor housing, poor diet, and pollution. For example, the affects that poverty and wealth have on illness and health, can be seen when we look at the crude life expectancy figures that indicate population health and actually mask significant health inequalities among social groups within a country (Germov 2005).The gap between rich and poor, or the connections between social In opposition to functionalism, when society exists in a state of balance and stability, conflict theory says that society is better described as existing in a state of constant struggle and conflict between two groups. Conflict theory has been growing it popularity since the late 1960s.

    Many social and economical problems such as, civil rights movements, and political battles, have given prime examples of the conflict between the two groups, reinforcing conflict theory.Carl Marx was a very important contributor to conflict theory. Marx says there is a constant struggle between the haves, and the have-nots. In a capitalistic society, groups interact in a destructive way.

    They do this by the more powerful group exploiting the lower group in order to become more powerful. This is what causes the unbalance in power. Conflict theorists view society as an arena in which different individuals and groups struggle with each other in order to obtain scarce and valued resources.When viewing society, conflict theorists believe that individual groups The majority of people in our society, rely on the National Health Service to provide their health care.

    Sociologists have carried out research that suggest that there is inequality in the services provided. Various factors are involved, firstly the area in which someone lives could cause them to receive inadequate care. Each health authority receives an located amount of money based on their need.This does not always occur fairly, specialist teaching hospitals attract more funding and are often in richer areas.

    London has always had a larger amount of funding than other areas with similar needs, it has lots of big well known hospitals and politicians fear losing votes if they cut the funding, especially as it is the capital city. Members of the lower social classes are also more likely to access the health service and take part in national screening programmes. There are barriers that may prevent them from using the health service as often as other classes.If someone is in a poorly paid job mundane job it is more difficult for them to obtain time off work to access services and to lose money to do this.

    Also due to their lifestyle they may suffer from stress related conditions, and not notice the first signs on illness as well as someone who is happy and healthy. In our society, the majority of citizens depend on the National Health Service to be there in their time of need. Certain sociologists have produced research which has reviled that there are in fact inequalities when health service is provided.The opponents of the social approach to health then tried to explain away the evidence of the link between health and inequality.

    They attacked the reliability of the data, focusing on what is called the health selection effect. Causation might run not from society to health but from health to society. For example, as unemployment rises we know that the unemployed will register more illness than the employed. So does unemployment make you sick or does being sick mean that you are more likely to be unemployed The attempts to focus on health selection, however, have failed.

    In most instances the causation does flow from society to health There is no evidence to support health selection as an explanation of broader social inequalities in health, wrote Marmot in 1994 and the evidence against the health selection hypothesis has grown. Opponents of the social model of health challenged the evident produced by The Black Report and suggested that the reliability and validity of the data was not sufficient. It is of course true that in seeking to explain class inequalities it health, which is our principal task, many factors other than health service usage prove relevant.As Martini, Allan, Davison and Backett (1977), amongst others, have shown differences in health outcome measures between populations may be far more a function of variations in the socio-demographic circumstances of the population than to the amount and type of medical care provided and/or available.

    Nevertheless, any inequality in the availability and use of health services in relation to need is in itself socially unjust and requires alleviation.This remains true whatever the proportional contribution which the health service makes to health, though its priority in social policy may well properly depend upon that proportionality. Moreover since, as Cartwright and OBrien (1976) point out, One of the fundamental principles of the National Health Service was to divorce the care of health from questions of personal means or other factors irrelevant to it (HMSO 1944), the extent to which this object has been achieved has been a matter of considerable interest.Thus, in 1968 Titmuss argued, on the basis of then available evidence, that inequality in receipt of care remained, that higher income groups know how to make better use of the Service they tend to receive more specialist attention occupy more of the beds in better equipped and staffed hospitals (Titmuss, 1968).

    In 1969 Rein (participating in the American debate about finance of health care) argued, on the basis of different evidence, that the British Health Service is in fact equitable in the treatment provided (Rein, 1969).But his assumption was that need for health care was uniform between classes, and he did not relate utilisation to need. A number of subsequent studies many of which we refer to below, have sought to cast further light on the extent of social equality/inequality in availability and use of health services. In Western Europe capitalism began to emerge from feudalism in the 16th century, and as it did so it began to change the pattern of disease.

    But the really dramatic shifts came with the industrial revolution and the development of industrial capitalism at the turn of the 19th century.Technological change and increased production created a larger surplus, which allowed societies to begin the demographic transition. They shifted from a pattern of high birth rates and high death rates to low birth rates and low death rates. In this transition, however, the death rate initially fell faster than the birth rate.

    The result was that rapid population growth occurred before a new balance was reached. Table 1 shows how world population has grown and its projected new equilibrium at around nine to ten billion (despite the fears of Thomas Malthus who believed that population growth would outrun the food supply).Inequalities in the Autonomous Communities of Spain Inequalities exist also in the utilization of health services, particularly and most worryingly of the preventive services. Here, severe underutilization by the working classes is a complex resultant of under-provision in working class areas, and of costs (financial and psychological) of attendance which are not, in this case, outweighed by disruption of normal activities by sickness.

    In the case of GP, and hospital in-patient and out-patient attendance, the situation is less clear.Moreover it becomes more difficult to interpret such data as exist, notably because of the (as yet unresolved) problem of relating utilization to need. Broadly speaking, the evidence suggests that working class people make more use of GP services for themselves (though not for their children) than do middle class people, but that they may receive less good care. Moreover, it is possible that this extra usage does not fully reflect the true differences in need for care, as shown by mortality and morbidity figures.

    Similar increases in the use of hospital services, both in-patient and out-patient, with declining occupational class are found, though data are scanty, and possible explanations complex. The Inequalities in Health Services Inequalities in human health take a number of distinctive forms in Britain today. In this report, for the reasons set out in Chapter 1, most attention is given to differences in health as measured over the years between the social (or more strictly occupational) classes. These differences are highlighted in Table 2.

    1 by comparing rates of mortality among men and women in each of the Registrar Generals 5 classes.Taking the 2 extremes as a point of comparison it can be seen that for both men and women the risk of death before retirement is two-and-a-half times as great in class V (unskilled manua1 workers and their wives), as it is in class I (professional men and their wives). If attention is confined to age-standardised deaths rather than all deaths of those aged 15-64 then the ratio for class V males becomes a little under twice (1. 8) that of class I (OPCS) 1978, P37) 2.

    2 This great gap in the life chances of men and women at the 2 polar ends of the occupational spectrum is, however, not the only source of health inequality for, as Table 2. also indicates, the risk of death for men in each social class is almost twice that of their wives The health models incorporate contrasting focuses, assumptions, causes of illness and interventions, yet both models have their benefits and their limitations. The Biomedical medical model addresses disease and disability of individuals in accordance the social medical model addresses the social determinants of health and illness. As the health models work in collaboration aspects of both prevention and cure are taken into accountEach model of health involves the process of examining health, ideas and assumptions of health, the cause of ill health and, but still, both the social and medical model have their strengths and weaknesses.

    The distribution of health or ill-health among and between populations has for many years been expressed most forcefully in terms of ideas on inequality. These ideas are not just differences. There may be differences between species, races, the sexes and people of different age but the focus of interest is not so much natural physiological constitution or process as outcomes which have been socially or economically determined.This may seem to be straight forward but the lengthy literature, and widespread public interest in the subject of inequality, shows that factors which are recognisably or discernibly man-made are not so easy to disentangle from the complex physical and social structure in which man finds himself.

    Differences between people are accepted all too readily as eternal and unalterable. The institutions of society are very complex and exert their influence indirectly and subtly as well as directly and self-evidently. For some the concept of inequality also carries a moral reinforcement – as a fact which is undesirable or avoidable.For others the moral issue is non-existent or is relatively inconsequential.

    For them differences in riches or work conditions are an inevitable and hence natural outcome of the history of attempts by man to build society and they conclude that the scope for modification is small and, besides other matters, of small importance. For many years now, the process of distribution ,when it comes to, health or ill health amongst and between societies has been expressed quite harsly in reference to ideas on inequality.Although this may be viewed as simplistic,but various pieces or work such as academic litriture and even national interest/fears regarding inequality reflects certain features which are quite easily man made. The most damning criticisms of Government policies we have heard in this inquiry have not been of the policies themselves, but rather of the Governments approach to designing and introducing new policies which make meaningful evaluation impossible.

    As one witness described, there is a continual procession of area-based initiatives and that in itself is quite disruptive.Nothing is given time to really bed in and function Even where evaluation is carried out, it is usually soft, amounting to little more than examining processes and asking those involved what they thought about them. All too often Governments rush in with insufficient thought, do not collect adequate data at the beginning about the health of the population which will be affected by the policies, do not have clear objectives, make numerous changes to the policies and its objectives and do not maintain the policy long enough to know whether it has worked. As a result, in the words of one witness, we have wasted huge opportunities to learn.

    Between the social and biomedical models of health, the definition of health tends to diverge, allowing the health models to cover a wider context of illnesses. There are a number of ways in which health can be defined some argue that to be healthy you must be free from any form of disease or abnormality. Others state to be healthy depends on your ability to satisfy the demands of life, your health as a result of your past, your lifecycle, your culture and also your personal responsibility (2002, White), these views supports both the social and biomedical models of health.Sickness is defined by the individual A choice exists whether people see themselves as ill or not, and those with power can choose whether to classify someone as ill.

    In most cases, those with power means doctors and other medical experts. (Browne 1998), as Kenneth Jones states Health and illness do not exist in isolation but within a specific socio political, cultural and interactive context (1991, Jones) so to accommodate the biomedical model focuses n risk behavior and healthy lifestyles and treats people in isolation of their environment. When comparing the Medical Model and the Social Model of health, the actual meaning of health usually expands, thus, allowing health theories to explore wider aspects of illness. Why, then, might it be that infant mortality in particular presents so dismal a picture Analyses quoted earlier suggest that infant death rates are associated with a number of characteristics of socio-economic and health systems.

    Low infant death rate seems clearly to be associated with per capita GDP, and there is some evidence for an association with an egalitarian income distribution (In other words distributional aspects of society – and the extent of income inequalities – may be related to national performance in the infant mortality rankings). So far as health policy is concerned, it seems that extent of provision of nurses and midwives, and of hospital beds, are more important than provision of physicians.Not unrelated, it seems that a relative emphasis upon preventive antenatal, and child health services within health policy is required. International comparison here may thus have implications for policy.

    It is possible, of course, that the superior performance of Sweden, Netherlands etc might be attributed to difference principally in the extent of internal inequalities. Thus, if the perinatal mortality rate for all England and Wales were equal to that of social classes I and II or the infant death rate equal to that obtaining in Oxford RHA, there would be little difference between these countries and ours.The second question, then, is whether the inequalities in health between social classes and regions, found in Britain, also exist elsewhere Materialism The motivating idea behind Marxs philosophy was the idea of materialism. Materialists believe that it is the material conditions of the world, for instance, the structure of the economy and the distribution of wealth, that give rise to ideas such as who should lead and deserves to earn what they earn.

    This idea is contrary to idealism, which states that it is ideas that give rise to material reality. Karl Marx idea ExploitationMarx believed that the real danger of capitalism was that it exploited workers. Marxists have since developed his theory to explore how capitalism also exploits the planet and its natural resources. According to Marx, capitalists exploit laborers by paying them less than they are worth — the excess labor of the laborer is what becomes the capitalists profits.

    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 Marx was writing.Marxs 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 that 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.

    Marx considered the capitalist class to be the most revolutionary in history, because it constantly revolutionized the means of production. In general, Marx believed that the means of production change more rapidly than the relations of production. For Marx this mismatch between base and superstructure is a major source of social disruption and conflict.The history of the means of production, then, is the substructure of history, and everything else, including ideological arguments about that history, constitutes a superstructure.

    Karl Marxs philosophical idea of history was produced after he researched and studied the difference between means of production such as land, raw material and factories as they are at the centre of the production for materialistic goods. Duringthi research, Marx found that European societies had eventually transferred from a feudal mode of means production to a capitalist dominant society.The struggle against dominant social relations and oppressive cultural norms has existed throughout human history. The large question for research on conflict resolution is, then, how we can identify sources of the dominant structure which generates conflict.

    This course takes an approach that the deep causes of environmental conflict, labor disputes, problems in urban communities, and violent culture should be understood in terms of the structural conditions of the modern society. For a while now, history has held the oppressive cultura norms and the struggles against domineering social relations.Researchers of this subject are keen to find out the sources of the dominant structure, which is the device that causes conflict. Recent research on inequalities in health in Britain has concentrated on the widening health gap.

    This study shows how that gap could be narrowed if some of the key social policies of the Government prove to be successful. The research, by Dr Richard Mitchell and Professor Daniel Dorling from the University of Leeds, and Dr Mary Shaw from the University of Bristol analysed every parliamentary constituency in Britain and tested a number of different social policy scenarios, using statistical techniques.The research suggests that Recent research regarding health inequalities in the United Kingdom has focused on the socially unequal widening health gap This reflects that the health gap can be narrowed if aspects of the key social policies within the Government prove to be a success. The essence of capitalism is economic freedom.

    Practices like ill-conceived subprime lending and crippling corporate fraud are side effects of a system that revolves around the individuals right to pursue his or her financial goals without the government getting involved.Capitalisms key early thinker, Scottish political economist Adam Smith, may have wanted economics separated from politics for its own good, but economics is nonetheless entwined with ideas about the individuals place in society. This connection has politics written all over it (witness the shouts of Die capitalist pigs heard around the world). The main theme of capitalism is economic freedom.

    Examples such as poorly-conceived lending and disabling corporate fraud are just a few of the side effects of a system that revolves around ones right to build her or his financial goals without any interventions from the government.References BBC. (2011). Life expectancy rises again, ONS says.

    Available http//www. bbc. co. uk/news/mobile/business-15372869.

    Last accessed 11th December 2011 Ken Browne (2002). Introducing Sociology for AS Level. 2nd ed. Cambridge Polity Press.

    113 UK National Statistics. (2009). Topic guide to Life Expectancies. Available http//www.

    statistics. gov. uk/hub/population/deaths/life-expectancies. Last accessed 11th December 2011 World Health Organisation.

    (2011). What is the WHO definition of health. Available http//www. who.

    int/suggestions/faq/en/index. html. Last accessed 11th December 2011

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