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In contrast to the medical model of health the social model of health views health as being influenced by a range of different factors, including those that are political, economic, social, psychological, cultural and environmental (as well as biological) (Earle, 2007a). The causes of ill-health are attributed to factors outside the physical body – the wider structural causes, such as inequality and poverty, as well as factors such as social interaction and behaviour. The notion of health is seen as being socially constructed, which is central to the social model of health and this idea is discussed in more detail later in the chapter.

The social model operates from the view that a wide variety of factors need to be taken into account when conceptualizing health – factors such as the environment, influences on lifestyle choices, access to health-care services, employment status and gendered identities, for example. The social model recognizes individual differences in health experience as being socially produced. In addition, it seeks to provide explanations for why differences exist. Crucially the social model of health also takes into account lay perspectives about health, which are discussed in more detail later in this chapter.

The social model of health is not without its critiques. It has been criticized for being so broad a model as to render it almost unusable. Kelly and Charlton (1995) argue that the social model cannot necessarily be viewed as superior to the medical model, despite criticisms of it. For example, they point out that while health promotion is premised on a social model of health in terms of the way that health is conceived (holistically), the discipline still relies heavily on expert knowledge that can be traced back to scientific origins. Therefore, science (and the medical model of health per se) has its part to play in understanding about the nature of health. The social model has also been criticized on the basis that the breadth of understanding it takes into account may lead to practices in health promotion and public health that have different priorities and therefore can only be implemented on a small scale. Earle (2007a: 54) therefore suggests that, rather than being able to pin down the ways that the social model of health may be used to, for example, improve or promote health, the ‘rhetoric’ of the social model of health has been used in the following ways:

 – as a set of underlying values (philosophical approach to health)

 – as a set of guiding principles to orientate health work in a specific way

 – as a set of practice objectives

In summary, the medical model views health as derived from biology, so ill-health is caused by biological factors that can be identified, diagnosed (as compared with a scientifically defined ‘norm’) and treated by expert medical knowledge. In contrast, the social model of health views it as socially constructed and influenced, so ill-health is caused by social factors, knowledge about ill-health is not confined to medical expertise and a more holistic, less reductionist view of health is subscribed to. Table 1.1 highlights the key differences between these two models.

The importance of social factors and the social model of health is demonstrated in Dahlgren and Whitehead’s (1991) rainbow of determinants (see part III, especially chapter 13).

Table 1.1 The medical model of health compared with the social model of health

Medical model	Social model
Narrow or simplistic understanding of health.	Broad or complex understanding of health.
Medically biased definitions focusing on the absence of disease or disability.	More holistic definitions of health taking a wider range of factors into account such as mental and social dimensions of health.
Doesn’t take into account the wider influences on health (outside the physical body).	Takes into account wider influences on health such as the environment and the impact of inequalities.
Influenced by scientific and expert knowledge.	Takes into account lay knowledge and understandings.