2.1 Why do we need a social model?
In Engel’s seminal work, the biomedical model was defined as assuming ‘…disease to be fully accounted for by deviation from the norm of measurable biological (somatic) variables. It leaves no room within its framework for social, psychological, and behavioral dimensions of illness’ (1977, p. 196). But this model clearly needs to be expanded to encompass a broader, more holistic approach to treatment and care. Although holism considers ‘the complete woman’ by looking, for example, for social and emotional explanations for their disease and symptoms (Henderson, 2014), the social model of health takes a different perspective. The social model explains health and wellbeing through the social context. Rather than starting with a woman in a particular state of health or disease, the main focus is on how living conditions and social factors affect health and wellbeing.
Looking at Dahlgren and Whitehead’s diagram (Figure 2), you could think of holism as starting with ‘Age, sex and constitutional factors’ and working outwards. By contrast, the social model would focus first on general socioeconomic, cultural and environmental conditions before working its way through the layers to eventually consider a woman’s constitutional factors.
Women frequently have limited control over the many sociocultural factors that affect their health and wellbeing. Therefore, the social model of health lends itself to campaigns arguing for social justice and better working and living conditions. In addition, the biomedical model isn’t always able to account for how sociocultural factors can interact with the diagnosis it is – or isn’t – able to provide, or how this can impact on a woman’s sense of wellbeing.
For example, Yvonne John is an author who has documented the experiences of childless women. In the following activity you will hear her speak about her own experiences around childlessness.
Activity 2 Wellbeing beyond the reach of biomedicine
Now answer the following questions.
- What role did biomedicine play when Yvonne and her husband were trying to conceive, and how was biomedicine unable to help her?
Yvonne received ‘infertility investigations’ that concluded she was unable to conceive. There was no particular cause found, which meant that there was no detectable ‘defect’ to treat medically.
- What challenges to Yvonne’s health and wellbeing did she face following the medical diagnosis? What was the impact of social and/or cultural expectations on her wellbeing?
Yvonne experienced many challenges, starting with the difficulties of talking to her family when she was experiencing shock and grief. She was grieving when there was no visible loss. She also talked a lot about how being diagnosed with unexplained infertility challenged the beliefs and cultural expectations of her and her family, and this further had an impact on her wellbeing, in particular:
- There was an expectation that there should be a way of fixing her infertility (perhaps referencing a biomedical approach).
- Yvonne experienced shame in not being able to live up to the expectation that she would one day become a mother. Being from an immigrant family increased the pressure of this expectation. Perhaps the pressure of having to be positive about the situation was the worst element.
- The diagnosis interfered with her sense of identity and belonging.
- She experienced religious challenges, particularly surrounding expectations of turning to God.
- What did help Yvonne?
Things that helped were simple human gestures, such as ‘being allowed to be sad’, receiving a hug and ‘being accepted for being sad’.
- Taking a social model perspective, what might you want to better understand in order to improve the health and wellbeing of Yvonne and other women in a similar situation?
If taking a social model perspective, you might want to understand why immigrant families feel the pressures they do. You might also want to look at the place of women in society regarding their reproductive roles and expectations.
The social model of health attempts to integrate social structures and women’s bodily existence in the world. It goes beyond the body to address the social, economic and environmental determinants of health. As you have learned, female reproductive health is one example where the social model offers a useful perspective. The biomedical model would consider reproductive health in relation to the body and reproductive roles, whereas the social model starts from the perspective of the social, cultural and economic, as well as equality issues. You will read more about the social model of health next.