Health is defined based on three dimensions: physical, mental and social health; a fairly recent modification from the 18th century viewpoints (Ware,1987). Health is perceived differently according to the different models of health that help in guiding and understanding of health and health issues. In relation to the following essay, two models; biomedical model and social model will be discussed and compared in terms of their relevancy in the modern times. The second half of the essay will focus on the effectiveness of the social model in explaining the increasing prevalence of health conditions related to the obesity epidemic.
During the early part of the 20th century, infectious diseases predominated as the highest cause of mortality in both developing and non-developing counties affecting 42% of the world’s population (Tulchinsky and Varavikova,2000; Boutayeb and Boutayeb,2005). This is the era that was heavily reliant on the biomedical model to diagnose illness which focused primarily on the proximal causes of disease (factors that act directly to cause a disease) and was confined to the objective measures for disease treatment (diagnosis solely based on medical facts without considering other possibilities)(Johnson,2012). Since the leading causes of death at those times were infections based i.e. pneumonia (11.8%), T.B. (11.3%) and diarrhoea (8.3%) (National Office of Vital Statistics,1947), the biomedical model’s germ theory which stated that all diseases were caused by pathogens that lead to a biological defect in the body, proved to be effective in the treatment and understanding of the communicable diseases(Johnson,2012). However, this also meant that the biomedical model was only limited to the biological factors (faulty genes, infections etc.) of disease and failed to acknowledge other diseases whose symptoms could not be explained in biological terms e.g. mental disorders or non-communicable diseases (NCDs). (Engel,1977)
As the society evolved, so did the pattern of diseases affecting the individual’s health. By the end of the 20th century a major shift in the disease pattern was noticed around the world from infectious diseases to NCDs such as heart disease (24.3%), cancers (23.3%), and cerebrovascular disease (5.2%) (Heron,2013) as the leading causes of deaths. (Tulchinsky and Varavikova,2000) This major paradigm shift of diseases was due to advancements in the medical techniques such as vaccinations but more importantly due to the improved social and economic factors in industrialised countries such as improved sanitation, hygiene, standards of living, environment, nutrition and globalisation (Tulchinsky and Varavikova,2000).Another major factor that contributed to the shift of diseases towards NCDs is due to the increase in the life expectancy of individuals from 47 years in 1900 to 77 years in 2000 (Johnson,2012). Increased proportion of older population meant that the population was more vulnerable to NCDs (chances of suffering from NCDs increase with age) as compared to the younger population in 1900’s that was more susceptible to communicable diseases (United Nations,2012).
Since the above mentioned NCDs were not caused by biological factors alone, the previously mentioned biomedical model of health failed to explain the modern health care challenge that accounted of 43% of deaths each year (Johnson,2012; World Health Organisation (WHO),2014). This created a demand for a new model of health that can expand on the existing knowledge from the biomedical model and also incorporate the social factors that contribute to NCDs.
Engel (1977) introduced the biopsychosocial model or the social model as an alternative to the traditional biomedical model. This model is a framework for understanding how different factors such as biological, behavioural, psychological and social have an impact on disease incidence. Compared to the biomedical model, the social model is based on the patient’s perspective (personal experience) for accurate diagnosis and treatment (, Suchman & Epstein, 2004). The social model focuses on both the proximal and the distal factors i.e. unlike the biomedical model; it not only focuses on an individual’s biological alterations to understand an illness but also the distal (social, psychological and behavioural) factors for understanding of diseases such as NCDs (Borrell-Carrio et al., 2004). Thus in the present day society where the diseases are driven by social factors, the biopsychosocial model is the most relevant model in addressing the current health care issues.
It is now important to apply the social models and evaluate their effectiveness in explaining the increasing prevalence of health conditions associated with the obesity epidemic.
Obesity is defined as the excessive build-up of body fat that has major detrimental effects on an individual’s health (Caballero, 2007). The major cause of this excess accumulation of body fat is due to a positive energy balance i.e. when the input of energy into the body system exceeds the output of energy which in turn facilitates in weight gain (Caballero, 2007). Obesity is a major health issue in modern day society, firstly because it affects approximately 300 million people worldwide (Weight Management Centre and secondly, drastic alteration in the body’s fat intake also leads to the increasing prevalence of other major health conditions such as cardiovascular disease, stroke, non-insulin dependent diabetes and hypertension (WMC, 2010).
With the use of social models, various factors affecting the increasing prevalence of health conditions related to obesity can be explained.
Firstly, the social models focus on the proximally based biological factors e.g. genetic susceptibility. This explains the individual’s ability to be genetically efficient in storing fat as compared to others. However these individuals with more ‘thriftier genotypes’ are more likely to have an increased fat storage capability and hence are genetically driven to have a higher likelihood for obesity (Candib, 2007).
Psychological impairment and stigmatisation on the basis of weight are examples of another biological factor, psychology, which the social models focus on. The stigmatisation of obese individuals as ‘voracious people’ has led to a development of self-depreciation and low self-esteem in the minds of obese individuals. Shame, guilt, loneliness are the major contributors that encourage the already overweight individuals to seek comfort by eating excessive food and therefore binge. Societal stigmatisation has impacted majorly on the psychological mind-sets of obese individuals and this in turn has led to an increase in the obesity epidemic as it becomes hard to motivate these individuals towards a healthier lifestyle (WMC, 2010).
Secondly, the models focus on the distal social factors which affect the population as a whole. The two most important social factors that play a key role in the rise of the obesity prevalence are globalisation and urbanisation. Urbanisation has had an impact on the energy expenditure and globalisation has had an impact on the energy intake. One of the classic examples of an urbanised environment is the development of the built environment. Built environments are the settings created by the society that play a key role in the access of individuals to resources. The increasing urbanisation has had a huge impact on these built environments making them obesogenic i.e. an environment that encourages the consumption of food (Callabero, 2007). With the modernisation of technology and transportation, the level of daily physical activity in the population has also decreased leading to a reduction in the energy expenditure opportunities (Hill and Peters, 1998)
On the other hand globalisation has led to a decrease in the prices of energy-dense food i.e. food rich in sugars and fat leading to its increased consumption. This can be seen between 1985 and 2000, as the prices of fruits and vegetables rose by 118%, the prices of food rich in sugar and fats rose by a mere 46%. This was the same period when the calorie intake in the population increased by 12% due to the high fat diet(Finkelstein, Ruhm and Kosa, 2005). The interactions of globalisation and urbanisation have encouraged sedentary lifestyles which promotes high energy intake but low energy expenditure (Reidpath, Burns, Garrard, Mahoney and Townsend,2002). Thus the unlimited supply of cheap, easily accessible, energy-dense food followed by minimal physical activity has pushed the world towards the obesity epidemic (Callabero, 2007).
The major advantage of the social model in comparison to the rather traditional biomedical model is its ability to extend its scope beyond the medical aspects of disease treatment. As mentioned previously the social model of health covers the psychological, behavioural and social factors and also incorporates the biological factors to explain leading health issues such as the obesity epidemic. The social model succeeds in providing a bigger picture of the health problems by linking various factors together e.g. psychological dependency on food and easy access to cheaper food items leads to an increase in the diet and weight of individuals which in turn increases the prevalence of obesity and other heath related conditions associated to it. The social model helps the world to be viewed from a wider angle and can help in creating health related policies towards obesity and the conditions related to it such as cardiac disease, diabetes, hypertension and stroke.
In conclusion, in comparison to the traditional biomedical model, the social model is more relevant and effective in explaining the current health patterns with minimal limitations. With the use of the social models, the current prevalence of the health related conditions related to the obesity epidemic can be explained and understood for further creation of interventions and health care policies. The social model opens a huge area of research that was previously overlooked by the biomedical model i.e. the use of social, behavioural and psychological factors to explain and diagnose an illness.

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