Health has always been a dominant concern of society, Virchow’s famous statement that medicine is nothing but politics on a grander scale has resonances not only for a sociological understanding of health but also for broader societal trends. In this regards sociological investigations into health have been one of the recurring themes of the discipline . Indeed in many instances sociologists have worked with health professionals in some of the landmark studies associated with health.
The modern western world is dominated by images of health, of healthy bodies and the oppositional fear of illness. Illness and threats of illness are perhaps the most problematic of modern conditions . Health stories dominate our media, for example one need only look at the recent experience with the SARS virus to see not only western concerns over health but how these concerns can migrate and affect the global environment. Even with the sophistication of modern medicine endemic diseases and epidemics threaten society or are perceived to threaten society. HIV, cancer and new resistant and deadly types of viruses are all threats to the social order and threats also to the individual’s sense of order . Even relatively isolated outbreaks such as cases of food poisoning receive large amounts of public attention and serve to highlight the degree of importance which is attributed to health by citizens.
Away from western concerns we can see that a vast gulf exists between
western and developing countries and their conceptions of and problems
with health. The rise of chronic illnesses in the west as the prime
incidence of illness contrasts starkly with the situation in much of
the world where the main threats are from diseases long eradicated in
the west. Indeed global patterns of inequality are not the only one
with western society replicating traditional patterns of inequality
related to income in health status .
Thus what is healthy and crucially how a healthy society is to be measured and gauged varies tremendously and is related strongly to where one is in the world. Indeed insomuch as sociology has had an interest in health this is in turn a reflection of the interest which society itself has in health . To western societies health is a critical component of social policy, in many countries it attracts and consumes the largest amounts of public expenditure and in individual’s daily lives notions of health and illness dominate our conceptions of ourselves
But what is it which we define as health and how do we define being sick. These questions are in turn related to what are the strategies we pursue in attaining our health related goals. The traditional medical model for answering these questions and defining the concepts involved is the bio-medical model and we can see the many sociological theories that have developed as arising out of dissatisfaction at the way in which the bio-medical model operates .
In this essay two of the most diametrically opposed models are examined, namely the bio-medical model above and the social constructivist model which has emerged since the late 1970s. These two theories represent critically different ways of conceiving of and thinking about health and illustrate also a much broader concern about trends in society reflected in and represented by these concerns with health and definitions of health.
This is the model perhaps of most familiarity to people and it is also the model which dominates not surprisingly the medical professions themselves. It is we might say the scientific model of health . In its simplest form we can say that at the root of this model is a reductionist logic common to all of the scientific disciplines. In other words this model proposes that the incidences of disease and hence abnormal conditions of health are located within discrete disease causing factors . It is the biomedical model which has dominated expert thought on health since the Enlightenment and indeed even before this as Greek medicine sought to explain disease and health through reference to the various ‘humours’ which comprised bodily make-up. Its influence can be felt not only within the medical professions but also across a wider spectrum of society. It has coloured our perceptions of health but even more importantly also our perceptions of illness as the biomedical model is most concerned when aberrations to health occur rather than with the ideal health state. Thus biomedical models are about the incidence of disease rather than the absence of health. This is a vital point for consideration as it reflects some of the dominant practices in health care . As such the bio-medical model represents the scientific neutrality perspective of medicine and the story it tells is one of human progress towards the conquering of disease .
These twin precepts, namely reductionism and supposed neutrality and progress have been criticised heavily from sociology . It is fair to state however that despite the criticisms levelled at the bio-medical model, some of which we examine subsequently in our discussion of an oppositional framework to the above that many of the medical advances with which we are familiar may possibly have arisen only out of the application of such a model. Thus while criticisms about the reductionism inherent in the position may be valid it must be allowed that advances based on the bio-medical model have been in instances effective in the diagnosis and treatment of illnesses.
However there are limitations even on a scientific ground. The bio-medical model with its emphasis on prolonging life for as long as possible is now in a paradoxical position due to the fact that by prolonging life and increasing life expectancy more people now survive for a longer period of time thus becoming more at risk from suffering from chronic as opposed to acute illnesses for which techniques developed as a result of the bio medical have had very little efficacy .
The bio-medical model has thus far proved to be at an impasse in relation to chronic illnesses and due to the reason that chronic illnesses are now the major form of illness within western societies it is not surprising then to note a shift away from unqualified support of the bio medical model and its practitioners among the general public towards a support of alternative practices of medicine . Signs of this shift can be seen in the increased support for both alternative practices and also within governmental policy where we can see a detectable shift in strategy away from the bio medical model reliance on curative medicine towards a more public health orientated preventative medicine .
But while the bio-medical model seems to be undergoing revisions its most strident critic can it be argued originate from social constructivist critiques of health, healthcare and medical knowledge generally.
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