Issues in complementary and alternative medicine
Issues in complementary and alternative medicine

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Issues in complementary and alternative medicine

1.5 Models of health care delivery

In the quest to understand health and illness behaviour, social and medical researchers have developed various models to explain the different forms of health care delivery. These models emerged because, in the mid-20th century, social researchers began to question not only the position of professions in western countries but also the relationship between professionals and users. Early explorations of the patient's role in health care suggested that it was fairly prescribed (Parsons, 1951), as was that of the physician (Freidson, 1970). However, by the 1980s there was greater awareness of the diversity of ways of receiving healing and health care, particularly in indigenous cultures. Currer and Stacey explain this in their ground-breaking overview of health concepts:

Any thorough-going critique of health care planning and administration requires the imaginative consideration of modes of healing based upon conceptualisations alternative to the contemporary dominant mode.

(Currer and Stacey, 1986, p. 1)

They also note that even within western cultures there are considerable variations across the population in the ways in which the dominant health care model is conceptualised:

Members also have access to, and possibly accept concepts derived from, other cosmologies or other modes of healing, and also from earlier formulations of biomedicine itself.

(Currer and Stacey, 1986, p. 1)

The medical anthropologist Arthur Kleinman (1980) notes that all healing systems orient around explanatory models of health and illness. He describes cultural explanatory models as cognitive orientations that determine how disease is named, defined and understood. He identifies the following six universal themes which underpin people's explanatory models.

  1. Aetiology: the cause of the illness.

  2. Time and mode of onset of symptoms: the significance of what was happening when the symptoms began.

  3. Pathology: what the illness is and what is going wrong with the person who is ill.

  4. Course of the illness: how long the illness might last and how it might develop.

  5. Consequences of the illness: the possible effects of the illness on the person's life.

  6. Treatment: what could be done to alleviate or cure the illness.

Four theoretical models are discussed in this section: the biomedical model, the biopsychosocial model, the salutogenic model and alternative or holistic models. Each is a conceptual model which provides a theoretical framework for how health is practised at both an individual practitioner and an institutional level. Eisenberg (1977) explains that models are ways of constructing reality, of imposing meaning on the chaos of the ‘phenomenal world’. Each model understands health, illness, the body, and the respective roles of users and healers in different ways. Note that the models described here are theoretical constructs (that is, they do not operate in a rigid way), and are not a blueprint for practice. In addition, few practitioners derive their ideas about health and illness solely from the models under discussion.

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