The Biomedical model of health is perhaps the oldest of health paradigms, where freedom from disease, pain or defect is the core focus. The physician typically inspects the patient ‘after’ the onset of an ailment and studies the pathology of disease, physiological mechanisms at play, as well as the biochemical processes. Under the biomedical model, the emphasis is on ‘cure’ and ‘healing’ through scientific application of medical principles as and when a medical condition presents itself. While this goal is perfectly legitimate, the critics of the Biomedical model point out its narrow focus, which largely leaves aside the social, economic and psychological factors that often precede and determine the health of an individual. (Wyman, 2000, p.77) It is due to this lack of wholeness in the conventional biomedical model of health, that scholars and thinkers have devised other wholesome perspectives of health. They have added newer dimensions to the study of human health, and the result is the invention of alternative perspectives such as the Biopsychosocial model of health (loosely referred to as the social model). The dominant discourse of the social determinants of health paradigm
“assumes a socio-environmental approach to health primarily “concerned with risk conditions rather than risk factors”. These conditions include poverty; income, gender, racial, and sexual inequality; stressful environments; housing and living conditions; education and early child care; food security; employment and working conditions; social inclusion and exclusion; and globalization. Efforts to attend to health inequities by anyone working under this paradigm would, therefore, address some or all of these issues.” (Ashcroft, 2010, p.251)
The Biopsychosocial paradigm was first expressed by physician George Engel in 1977, where he asserted that human beings are “dynamic systems whose functioning depends on the holistic integration of biological, psychological, and social factors; indeed, according to the biopsychosocial model, these factors are fundamentally interrelated and interdependent.” (Garland & Owen, 2009, p.191) What Engel was critiquing was the reductionism of the then dominant biomedical model, “which assumed that molecular biological processes (for example, genes, biochemistry) immutably dictated physiology and behaviour, a simpleminded biological determinism nonetheless took root, becoming widely and uncritically accepted.” (Garland & Owen, 2009, p.191) At the time of Engel’s introduction of this new model, he was met with much scepticism. But recent evidence and empirical data validate his theory.
The Biomedical model is as old as the history of modern medicine, where the emphasis is laid on scientific and rational understanding of pathology. This included a thorough approach to comprehending the biological mechanisms down to their molecular level. While this model largely holds forte within the confines of the clinic, it proves inadequate in explaining or addressing why some individuals/communities are more prone to certain illnesses than others. In other words, vast strides were made under the Biomedical model, in terms of advances in technology and the standards of medical professions. Yet, there was also the accompanying thought that people’s health conditions do not purely depend on advances in science and the medical professions but are also greatly influenced by social factors of well-being. And this is where, one begins to see chinks in model’s armour. A classic case in point is the spread of tuberculosis. As statistics on this feared epidemic shows,
“the biomedical knowledge of this disease and of its cure, the penicillin vaccine, is a crucial but in itself insufficient factor to successfully fight the epidemic: more important have been and continue to be the battle against social inequalities and the improvement in living conditions and educational levels of the poorest sections of the population. Above all, public health, and society’s commitment to a TB-free environment as a ‘public good’, more than biomedical science, have been and still are crucial factors in the eradication of this epidemic. As the TB example shows, the degree of social well-being of individuals, social groups and populations influences both their health needs and the effectiveness of health professional performance, both in terms of demand and supply.” (Leonardis, 2006, p.19)
The litmus test for the efficiency and effectiveness of any public health system (as well as for the health model it espouses) is its performance in a crisis situation. Civil societies have come to expect basic protections at the time of these crises. Such emergencies also test a government’s/ true ability to act under pressure. In other words, “they define a state’s capacity to protect its population while exposing its vulnerabilities to political upheaval in the aftermath of poorly managed crises” (Gorin, 2002). In the context of economic globalization at the turn of the new millennium, more than ever before, the general public demand transparency and accountability in global public health systems during medical and natural disasters. To gauge the robustness of conventional health models in this new globalization paradigm, we need to study recent cases of acute public health emergencies. The Indian Ocean tsunami of 2004 and Hurricane Katrina are particularly relevant to this analysis. In the cases of Hurricane Katrina and the Indian Ocean tsunami, the advantage of a globally coordinated public health arrangement comes to light. It also goes on to show that tackling (if not preventing) such crises in the future should begin through structural and systemic re-adjustments to public health systems. What these two examples prove is that the scope of the biomedical model (as it exists today) is too narrow to satisfactorily address natural disasters and other public health emergencies. (Brocato & Wagner, 2003, p.118)
Another area where the weaknesses of the biomedical model are exposed is in dispensing care and treatment for mental illnesses. A mental illness is a disorder that causes mild to severe abnormalities in thinking, cognitive functions and behaviour patterns of the affected people. If these disturbances are too severe, they may impair a person’s ability to cope with life’s ordinary demands and routines. Mental illnesses are still stigmatized in contemporary society, in spite of a general increase in awareness about such diseases as depression and anxiety. Even the very term ‘mental illness’ has a negative connotation to it as opposed to ‘physical illnesses’. The widespread perception is that mental illnesses are somehow ‘worse’ and patients afflicted with it “unpredictable” and “dangerous”. While such labels are applicable to a small fraction of patients, a majority of them are ‘normal’ individuals by common standards. Their disorders and disturbances only affect their concentration, cognition and efficiency. Yet, they get ostracized for their condition. It is not an even keel with all types of afflictions. Some of them like schizophrenia are subject to more ridicule and stigma than say depression. (Naidoo & Wills, 2005, p.221)
Where the biomedical model has let down society is in interpreting mental illnesses as largely due to ‘imbalances’ in certain chemicals in the brain. For example, depression is believed to be due to an inadequate supply of serotonin, norepinephrine and dopamine in certain cerebral regions. This view fails to adequately account for the psychological factors that lead to a state of depression. Some of the anti-depressant and anti-psychotic medicines currently in use (more popular ones include Zoloft, Prozac, Lexapro, etc) have not been studied for their long-term usage. Consequently, reports of detrimental effects of these drugs and their intolerance in the long run are emerging slowly. Not only is the biomedical model of psychiatric treatment contested in its therapeutic approach, but it is also intertwined with the interests of the powerful pharmaceutical industry. As it functions today, the health care industry is designed to ensure sustained profitability of pharmaceutical companies, insurance companies, private hospitals, etc. This condition should alter radically and the emphasis should be laid on meeting the health-care needs of patients. In other words, an ethical healthcare system, informed by the biopsychosocial model, should put people’s healthcare needs above corporate profits. (Graham, 2000, p.44)