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What is "health", and who gets to decide whether a person is healthy or ill? At first glance this seems an obviously biological question — a matter for doctors, blood tests and scans. Yet the moment sociologists ask it, the apparently natural categories of "health" and "disease" begin to look like social products. This opening lesson introduces the single most important conceptual distinction in the sociology of health: the contrast between the biomedical (medical) model, which treats illness as a malfunction of the body to be diagnosed and cured by medical experts, and the social model, which treats health and illness as shaped by social conditions, social meanings and social relationships. Almost every later debate in this option — about who falls ill (class, gender, ethnicity), about what counts as illness (mental health, disability), and about who has the power to define and treat it (the medical profession) — is built on this foundation. Getting it precise here is what allows you to analyse the rest.
Key Definition: The biomedical model of health defines health negatively, as the absence of disease, and locates both disease and its cure in the individual physical body. The social model of health defines health positively, as a state of complete physical, mental and social well-being, and locates the causes of ill health in social, economic and environmental conditions rather than only in the body.
This lesson addresses the opening content of the AQA A-Level Sociology (7192) specification, Paper 2 (Topics in Sociology), Section A — Health:
The specification expects you to describe (AO1) the biomedical and social models and key sub-concepts (the sick role, the biopsychosocial model, surveillance medicine), apply (AO2) these to an Item, and evaluate (AO3) the claim that health is best understood medically rather than socially. Because Section A questions are drawn from this content, the vocabulary established here — biomedical model, social model, the sick role, medicalisation, iatrogenesis, lay beliefs — is assumed in every later lesson and in the 10- and 20-mark questions.
Before comparing models, notice that "health" itself resists a single definition. Mildred Blaxter (1990), in a large national survey of lay (everyday) definitions of health, found that ordinary people define health in several overlapping ways: as the absence of illness; as physical fitness and energy; as the ability to function in everyday roles; and, more positively, as psychological well-being and being "in harmony". Crucially, these definitions were socially patterned: younger people stressed fitness and energy, older people stressed the ability to function despite ailments, and definitions varied by class and gender. This finding is itself an argument for the social model: if health is defined differently by different social groups, then "health" cannot be a purely biological constant.
The contrast between definitions is often summarised through the World Health Organisation's famous formulation that health is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". This positive, holistic definition explicitly rejects the purely negative biomedical view and is frequently cited as the charter of the social model.
Lay vs professional definitions: Professional (expert) definitions of illness rest on clinically measurable signs and diagnostic categories. Lay definitions rest on how people themselves experience and interpret their bodies. The two often diverge — a person may feel ill with no diagnosable disease, or be diagnosed with a "disease" they do not experience as illness — and this gap is central to the sociology of health.
The biomedical model has dominated Western medicine since roughly the nineteenth century, when germ theory (the discovery that specific micro-organisms cause specific diseases) gave medicine enormous prestige and apparent precision. Its core assumptions are:
| Assumption | Explanation |
|---|---|
| Health is the absence of disease | Defined negatively: you are healthy if no pathology can be found |
| Mind–body dualism | The body is treated as a machine separable from the mind; illness is a malfunction of physical parts |
| Specific aetiology | Each disease has a specific physical cause (a germ, a gene, a lesion) that can in principle be identified |
| Medical intervention cures | Illness is treated by technical, often biochemical or surgical, intervention delivered by trained experts |
| The hospital and the doctor are central | Health care is doctor-centred and increasingly hospital-based; the patient is a relatively passive recipient |
| Scientific objectivity | Medicine is presented as a neutral, value-free natural science |
The biomedical model is associated with extraordinary achievements — antibiotics, surgery, vaccination, anaesthesia — and it remains the operating assumption of most clinical practice. Sociologically, however, its very success has invited critique, because it tends to treat the body as the unit of analysis and to ignore the social conditions that make bodies ill in the first place.
The classic sociological account of how the biomedical model functions in society is Talcott Parsons' (1951) concept of the sick role. Writing from a functionalist standpoint, Parsons argued that illness is potentially dysfunctional for society because a sick person cannot perform their normal social roles (worker, parent). Society therefore needs to manage illness so that it does not become a tempting escape from obligation. The sick role is a temporary, socially sanctioned status with two rights and two obligations:
| Rights of the sick person | Obligations of the sick person |
|---|---|
| To be exempted from normal role responsibilities (e.g. time off work, "doctor's note") | To regard being sick as undesirable and to want to get well |
| To not be blamed for the illness — it is seen as beyond their control | To seek competent help (the doctor) and to cooperate in getting better |
Parsons saw the doctor as the gatekeeper who legitimates entry to the sick role, ensuring that exemption from duties is not abused. For Parsons, then, medicine is an agency of social control that returns deviant (sick) individuals to productive social functioning — a strikingly social analysis built on top of a biomedical conception of disease.
graph TD
A["Illness as potential dysfunction"] --> B["Society must regulate it"]
B --> C["The sick role"]
C --> D["Rights: exemption from duties + not blamed"]
C --> E["Obligations: must want to recover + seek competent help"]
E --> F["Doctor as gatekeeper"]
F --> G["Medicine as agency of social control"]
G --> H["Sick individual returned to productive role"]
The sick-role model has been heavily criticised, and the criticisms double as an introduction to the social model:
The social model turns the biomedical model on its head. Its starting point is the historical observation, associated with Thomas McKeown (1976), that the dramatic decline in mortality from infectious disease in nineteenth- and twentieth-century Britain occurred largely before the major medical interventions (most antibiotics and immunisations) became available. McKeown argued the decline was driven mainly by improved nutrition, sanitation, clean water and rising living standards — that is, by social change, not medical breakthrough. Although McKeown's thesis has itself been debated, it powerfully reframes the question: if social conditions, not doctors, produced the great health gains, then health is fundamentally a social matter.
Core claims of the social model:
| Claim | Explanation |
|---|---|
| Health is positive well-being | Not merely the absence of disease but physical, mental and social flourishing (the WHO definition) |
| The social causes of ill health | Poverty, poor housing, dangerous work, diet, stress and pollution are the upstream causes; disease is the downstream symptom |
| Health is socially patterned | Ill health is systematically distributed by class, gender, ethnicity and region — not randomly across the population |
| The body is socially shaped | What counts as a healthy or ideal body, and how the body is experienced, is culturally and historically variable |
| Health care should be holistic and preventive | Tackling the social determinants (e.g. reducing poverty) is more effective than treating individuals one by one downstream |
A widely cited bridge between the two models is George Engel's (1977) biopsychosocial model. Engel, a physician, argued that the purely biomedical model was scientifically incomplete because it ignored the psychological and social dimensions of illness. His model holds that health and illness result from the interaction of biological factors (genes, pathogens), psychological factors (beliefs, stress, behaviour) and social factors (relationships, work, poverty). The biopsychosocial model is important because it shows the choice between models need not be all-or-nothing: it retains biological causation while insisting that social and psychological context co-determine both the onset of disease and its course. It is now influential in fields such as chronic-pain management and mental health.
The most radical critique of the biomedical model comes from Ivan Illich (1976) in Medical Nemesis. Illich argued that modern medicine has become a threat to health through iatrogenesis — illness caused by medicine itself. He distinguished three types:
| Type of iatrogenesis | Meaning |
|---|---|
| Clinical iatrogenesis | Direct harm done by medical treatment — side-effects, infections, errors, harmful drugs |
| Social iatrogenesis | The medicalisation of life: ordinary experiences (birth, ageing, unhappiness, death) are turned into medical problems requiring expert management |
| Cultural iatrogenesis | Medicine erodes people's capacity to cope with pain, suffering and death on their own terms, creating dependency on the profession |
Illich's argument that medicine can manufacture dependency and harm is a cornerstone of the social-model critique and connects directly to debates about the power of the medical profession (lesson 10) and about medicalisation (the social-construction lesson).
The table below draws the contrast together — the single most examinable comparison in this lesson.
| Dimension | Biomedical (medical) model | Social model |
|---|---|---|
| Definition of health | Negative: absence of disease | Positive: complete physical, mental, social well-being |
| Locus of illness | The individual physical body | Social, economic and environmental conditions |
| Cause of ill health | Specific physical pathology (germ, gene, lesion) | Poverty, housing, work, diet, stress, inequality |
| Mind and body | Separate (dualism) | Interconnected; the body is socially shaped |
| Who is the expert? | The doctor; the patient is largely passive | Lay knowledge matters; care should be collaborative and preventive |
| Site of care | Hospital, clinic, surgery | The community, the workplace, public policy |
| Best remedy | Technical intervention (drugs, surgery) | Tackling the social determinants of health upstream |
| Associated theory | Functionalism (Parsons) treats medicine as social control | Marxism, feminism, interactionism; the social-determinants tradition (Marmot) |
A useful way to hold the distinction is the metaphor of upstream and downstream: the biomedical model rescues people who are already "drowning" downstream (treating disease), while the social model asks why they keep falling in the river "upstream" (the social conditions causing disease). Neither is wholly wrong; the debate is about emphasis and about power — whose definition of health prevails, and in whose interests.
Because the choice between models is ultimately about power, it is essential to see how the major sociological perspectives line up. The table above gestured at this; the following draws it out, since examiners reward candidates who can attach the models to theory.
Functionalism (Parsons) is broadly comfortable with the biomedical model. It treats illness as a dysfunction to be managed, the sick role as a mechanism of social control, and the medical profession as performing a positive integrative function for society — returning the sick to their productive roles and policing access to legitimate exemption. Medicine, on this view, is a neutral, beneficial institution that helps society run smoothly.
Marxism (Lesley Doyal, Vicente Navarro) reads health through the lens of capitalism and class conflict. Marxists argue that capitalism is itself a major cause of ill health: dangerous and stressful work, poverty wages, inadequate housing, and the marketing of unhealthy commodities (tobacco, ultra-processed food, alcohol) all damage workers' bodies in the pursuit of profit. They further argue that the biomedical model is ideologically convenient for capitalism: by locating illness in the individual body and treating it downstream, it diverts attention from the systemic, profit-driven causes of disease and presents health as a matter of individual misfortune or lifestyle rather than of exploitation. The medical profession and the pharmaceutical industry, on this account, function partly to keep the workforce productive and partly to generate profit, which is why Navarro insisted that the politics of health — who controls resources — matters more than clinical technique.
Feminism (Ann Oakley) reads health through the lens of patriarchy, arguing that medicine has historically been a male-dominated profession that has taken control of women's bodies — medicalising childbirth, menstruation and the menopause, and defining women's normal processes as conditions requiring expert (male) management. (This is developed fully in the gender-and-health lesson.)
Interactionism (Goffman, labelling theory) rejects the biomedical model's claim to neutral objectivity, arguing instead that health and illness are meanings negotiated between doctor and patient, and that the diagnostic label — and the stigma attached to it — shapes the experience of illness as much as any underlying pathology. (This is developed in the social-construction lesson.)
| Perspective | View of illness | View of the medical profession |
|---|---|---|
| Functionalism | A dysfunction to be managed; the sick role | A beneficial agency of social control and integration |
| Marxism | Largely caused by capitalism; the biomedical model is ideological | Keeps the workforce productive; serves profit |
| Feminism | Women's bodies medicalised under patriarchy | Historically male control over women's health |
| Interactionism | A negotiated meaning and a label, not just a pathology | Powerful definers whose labels carry stigma |
Holding these perspectives clearly is what allows you to turn a descriptive comparison of "two models" into a genuinely sociological analysis of competing theories — exactly the move the 20-mark essay rewards.
The biomedical model has genuine explanatory and practical power, but its individualism is its weakness. Germ theory, surgery, antibiotics and vaccination are real achievements, and specific-aetiology reasoning has saved countless lives. However, by locating illness in the individual body it systematically brackets out the social conditions that make bodies ill, leading to a "treat the symptom, ignore the cause" approach that the patterning of disease by class and ethnicity (lessons 3–5) shows to be inadequate.
Parsons' sick role illuminates the social regulation of illness, but assumes a consensus that does not hold. The insight that medicine functions as social control is durable and genuinely sociological. Yet the model fits only acute, curable illness, ignores chronic conditions, presupposes a harmonious doctor–patient relationship, and overlooks the unequal capacity of different social groups to access the sick role in the first place — so it describes an idealised case rather than the patterned reality.
The social model captures the social determinants of health that the biomedical model misses, but can understate biology. McKeown's history, Blaxter's lay definitions and the inequality evidence make a strong case that health is socially produced. The risk is sociological reductionism — explaining everything socially and underplaying genuine biological causation (genetic disease, infection). The biopsychosocial model (Engel) is therefore attractive precisely because it refuses the either/or and integrates biological, psychological and social causation.
Illich's iatrogenesis thesis exposes medicine's hidden harms, but may overstate them. The concepts of clinical, social and cultural iatrogenesis powerfully challenge medicine's self-image as purely beneficial, and the medicalisation critique has been hugely influential. However, critics argue Illich romanticises pre-modern coping and ignores the net benefit of modern medicine; the reasonable position is that medicine is both a major source of well-being and a source of new harms and dependencies.
The most defensible overall position is neither pure model but a recognition of power. Because the choice between models is ultimately about who defines health and in whose interests, the strongest analysis treats the biomedical model not as simply true or false but as the dominant model — institutionally entrenched, professionally policed, and consequently shaping policy in ways that favour downstream treatment over upstream prevention. This frames the entire option.
Item A
Sociologists disagree about how best to understand health and illness. The biomedical model treats illness as a malfunction of the individual body, to be diagnosed and cured by medical experts. Critics argue that this approach ignores the social conditions in which people live, and overlooks the ways in which medicine itself can shape, and even create, what counts as illness.
Applying material from Item A, analyse two limitations of the biomedical model of health. (10 marks)
AO breakdown: this question is marked for AO1 (knowledge of two relevant limitations), AO2 (application — both points must be "hooked" to the Item), and AO3 (analysis — developing each point logically). There are no marks for a long evaluation; the skill is selecting two distinct, Item-anchored limitations (e.g. that it "ignores the social conditions in which people live" → the social-determinants critique; that "medicine itself can shape, and even create, what counts as illness" → medicalisation/iatrogenesis) and developing each in a tight paragraph that quotes a phrase from the Item.
Item B
The biomedical model has dominated modern medicine and is credited with major advances such as antibiotics, vaccination and surgery. However, some sociologists argue that the great improvements in health over the last two centuries owed more to better living conditions than to medical treatment, and that health and illness can only be properly understood in their social context.
Applying material from Item B and your knowledge, evaluate the view that health and illness are best understood through the social model rather than the biomedical model. (20 marks)
AO breakdown: on Paper 2 the 20-mark essay is marked AO1 (≈8) for knowledge, AO2 (≈4) for sustained application to the Item, and AO3 (≈8) for evaluation. (Note: Paper 2 essays are 20 marks, not 30.) AO1 requires both models, Parsons' sick role, McKeown, Engel and Illich; AO2 requires repeated explicit engagement with the Item's two sides (medical advances vs the living-conditions argument); AO3 requires weighing the social model's strengths against the risk of reductionism and reaching a substantiated judgement (e.g. the biopsychosocial synthesis).
Mid-band response:
The social model says that health is about social conditions, not just the body. As the Item says, improvements in health came from better living conditions like clean water and food, which is what McKeown argued. The biomedical model just looks at the individual body and tries to cure disease with drugs and surgery. The social model is better because it looks at things like poverty and housing, which cause illness. Illich also said that medicine can cause illness, which he called iatrogenesis, so doctors are not always good for you.
However, the biomedical model has done a lot of good things, like antibiotics and vaccinations, as the Item says. Parsons said that the sick role is important because it stops people pretending to be ill. So the biomedical model is still useful. Overall, the social model is better because it looks at the bigger picture, but the biomedical model is still needed to cure people, so we need both.
Stronger response:
The view in Item B is essentially the social model of health: that health and illness are produced by social conditions and can only be understood in social context. Its strongest historical support is McKeown (1976), who argued that the decline in mortality from infectious disease in Britain occurred before most medical interventions and was driven by improved nutrition, sanitation and living standards — exactly the Item's claim that improvements "owed more to better living conditions than to medical treatment". The social model adds that ill health is patterned by class, gender and ethnicity, and that medicine can itself harm through iatrogenesis (Illich 1976), including the medicalisation of ordinary life. Blaxter's (1990) finding that lay definitions of health are socially patterned reinforces the claim that "health" is not a biological constant.
However, the Item also acknowledges the biomedical model's real achievements, and these are not trivial. Germ theory, antibiotics, surgery and vaccination have saved millions of lives, and specific-aetiology reasoning underpins effective acute care; Parsons (1951) further shows the biomedical framework performs an important social function through the sick role, which regulates illness as a form of social control. The danger in the pure social model is sociological reductionism — explaining away genuine biological causation. The most defensible conclusion is that Engel's (1977) biopsychosocial model is superior to either pure model, because it integrates biological, psychological and social causation, so the social model is a necessary corrective to biomedical individualism rather than a complete replacement.
Top-band response:
Item B counterposes the biomedical model's undisputed clinical achievements against the social-model claim that the great health gains were social, not medical, in origin. The strongest case for the social model must be stated precisely. McKeown's (1976) thesis is not merely that living conditions helped but that the timing refutes the biomedical story: if mortality from infectious disease fell substantially before effective immunisation and antibiotics, then the decisive variables were nutrition, clean water and sanitation — upstream social determinants — and medicine's curative role has been overstated. This reframes health as something produced by the social structure, a claim the inequality evidence (the patterning of disease by class, the inverse care law) then corroborates. Blaxter (1990) deepens it: if even the definition of health is socially patterned by age, class and gender, "health" cannot be the biological constant the biomedical model assumes. Illich's (1976) iatrogenesis — clinical, social and cultural — supplies the sharpest edge, arguing medicine can manufacture both harm and dependency, while the medicalisation thesis shows the biomedical model is also a structure of professional power.
The discriminating move, however, is to specify the limits of the social model rather than simply endorse it. McKeown's thesis is itself contested, and a model that explains everything socially risks reductionism, neglecting infection and genetic disease where specific-aetiology reasoning genuinely applies; Parsons' sick role, meanwhile, shows the biomedical framework is sociologically productive, not merely a foil. The resolution is not to crown one model but to recognise, with Engel (1977), that biological, psychological and social factors interact — and, more sharply, to see that the real question the Item raises is one of power and emphasis: the biomedical model is "dominant" not because it is uniquely true but because it is institutionally entrenched and professionally policed, which is precisely why health policy tilts towards downstream treatment over upstream prevention. The judicious conclusion is therefore that the social model is indispensable for understanding the social production and distribution of ill health, but is most powerful when it absorbs, rather than discards, biomedical and biopsychosocial insight. The Item's "either/or" is thus a false choice that the sociology of health is designed to dissolve.
The Mid-band answer shows accurate but underdeveloped knowledge: McKeown, Illich, Parsons and both models are named, and the two sides of the Item are recognised, but points are listed rather than analysed, application to the Item is implicit, and the conclusion ("we need both") is asserted rather than reasoned. It would sit in the middle band for AO1 and AO3 with limited AO2. The Stronger answer adds precise content (McKeown's timing argument, Blaxter's patterned lay definitions, the three types of iatrogenesis, the sick role as social control) and, crucially, explains why the social model is a corrective rather than a replacement, reaching a measured biopsychosocial judgement that lifts it towards the top of the band. The Top-band answer demonstrates the discriminating features examiners reward: it distinguishes the timing refutation from a mere "living conditions helped" point, prioritises the question of power and dominance over a simple model-comparison, marshals reductionism as the decisive limit on the social model, integrates Engel's synthesis, and reaches a calibrated judgement that dissolves the Item's false dichotomy. The Item is engaged explicitly throughout (AO2), which is exactly what is expected.
This content is aligned with the AQA A-Level Sociology (7192) specification.