There is a dramatic improvement in the health status over the past 100 years (Clarke 2010). Biomedical model now dominates in most of the developed nations as one of the accepted modern scientific medicine. By the development of Germ theory and preventive medicine biomedical model emerged in the early 19th century (Haralambos and Holborn 2004).
In this essay the author will discuss the role of biomedicine and social factors in the improvement of health status of the people. There is a debate among sociologists that the improvement in the health status is as a result of social and environmental factors, life circumstances and social and family relationships (Rootman 2010).
THE BIOMEDICAL MODEL
According to Decker this is a dominant disease model which assumes disease to be a deviation from the norm of measurable variables without accounting for the social, psychological and behavioural dimensions of illness (cited in Clarke 2010).
Nettleton (2006) explains the five assumptions of biomedical model as she states there is mind and body dualism, where both are treated separately. The second one is, it treats body like a machine that can be repaired. As it overplayed the technological interventions it is known as technological imperative. Being neglecting the social and psychological factors, this acts as a reductionist. Finally by 19th century The Germ Theory was developed by the fact that every disease is caused by a specific agent, for example, parasites and viruses. Biomedicine claims its own knowledge is objective and scientific.
By the development of biomedicine physicians became interested in specific body parts where the disease affected rather than its impact on the whole person (Hyde et al 2004). Davey and Seale pointed out the role of hospitals in the growth of clinical medicine (cited in Hyde et al 2004). By the approval of the Medical Registration Act, biomedicine achieved a legal recognition. Nettleton (2006) notified the improvement in cancer treatment where it is no longer considered as life threatening.
The author thinks modern technology is a good thing as it has made many improvements, for example surgery where impossible few decades ago, and general anaesthetics were used commonly which has many disadvantages. By the development of new technology most operations can be conducted through key holes, which helps fast recovery and less complications. Along with these advantages, she thinks biomedicine definitely has some disadvantages.
CHALLENGES AND DISADVANTAGES OF BIOMEDICINE
Nettleton (2006) pointed out some disadvantages of biomedicine. The body is isolated from the person and social and material causes of illness are neglected. She thinks the meaning of health and illnesses are irrelevant. Shryock states medicine has developed his own history with accurate knowledge of disease by eradicating certain diseases and by promising further advancement in control of many other diseases (cited in Nettleton 2006).
Medical sociology became as powerful as they became keen to understand people, they became more patient centred with a marked improvement in the physician and patient relationship (Nettleton 2006).
Hyde et al (2004) strongly mentioned about the clinical iatrogenesis leading to antibiotic resistance which leads to superbugs. Many evidences suggest that patient suffer treatment induced morbidity.
Florence nightingale stated that the very first requirement of in a hospital that it should do the sick no harm. Over the last 150 years the percentage of patients who acquire infections after admitting to hospital has increased. According to statistical findings in 2005, about 5000 people die as a consequence of healthcare associated infection every year (Pickup 2005).
SOCIOLOGICAL IMPACT ON BIOMEDICINE
Giddens (1989) explained the modern medicine introduced a view of illness as physical with application of science in diagnosis and cure as its major feature, whereas Clarke (2010) states that peoples experiences of health and disease are seen as being influenced by the social, economical and cultural characteristics of the society in which they live.
Hyde et al (2004) mentioned that the life expectancy statics in Ireland for the period 1881-83 indicated an average life expectancy of 49.6 years and by 2004 it increase to 76.7 years. In ancient Rome, the life expectancy was 25, in 1900 it was 41, and over the next 100 years it increased to 79 years as mentioned by The Royal Institute of Public Health (2003). According to Royal Institute, public health is largely responsible for this greatest increase in lifespan. Thomas Mckeown cited in Hyde et al (2004) strongly asserted that the increase in life expectancy during the 19th century occurred mainly through improvement in nutritional status rather than sanitation and hygiene, whereas medical contribution was only 17% according to Taylor (cited in Naidoo and Wills 2000).
Illich cited in Hyde et al (2006) stated that there are arguments that the better health outcome for people in industrially developed countries has less to do with biomedicine, but it is because the physicians tend to gather where people are employed, able to pay for better services including pure water supply.
On the other hand biomedicine has an impact on social realm, for example people tend to rely on plastic surgery, not because of any organic disease, just because they do not like their appearance as mentioned in Hyde et al (2004).
EVIDENCE BASED MEDICINE AND PUBLIC HEALTH
Evidence based medicine bridges the gap between research and practice in medicine. Trinder and Reynolds (2000) suggested that it is important to make sure the research findings are properly disseminated to doctors and to evaluate the findings are delivered into current practice. This aims to promote the most effective care of the patients.
The reports from House of Lords committee on science and technology (1987-88) pointed out that even there were relevant research findings for the improvement of public health and the management of health service, there was no system to ensure that those results were translated into practice. Later, Trinder and Reynolds (2000) mentioned that the evidence based medicine programme shifted their focus on evidence based patient and public choice. Public health remained as the centre of most of the health care decision making and initiatives.
In response to the critics as mentioned by Nettleton (2006) all the medical and healthcare interventions are to be evaluated according to outcome and cost effectiveness. People began to take control on their health matters as illustrated by Illich (cited in Nettleton 2006). Medicine and sociology have some more in common as both focus on health, not only in illness.
Researches done on the public’s awareness of health concluded that lifestyle has a vital impact on peoples’ health and illness. Smoking, stress and exercise are presumed to be important determinants of health (Blaxter, 1997).
Alternative to biomedical model, the biopsychosocial model, was developed by Engel which include patient as well as illness (cited in Clarke 2010). As mentioned by Clarke (2010) criticisms were either pragmatic or fundamental, those who criticised pragmatically accepted the principle of biomedical model, but underlined the failure to provide full aetiology of disease and it only focused on biochemical processes. On the other hand, fundamentalists emphasised the importance of social dimensions to the creation of medical knowledge.
PUBLIC HEALTH INITIATIVES
The notion of public health started 400 years ago with the aim to prevent further spread of disease. Ellis and Ventra (2004) states, health consumers are now more active in their personal health and the health of loved ones, as they are faced with informed health care decision making. “In future public health practice should be based on flexibility and pragmatism” says Ricciardi (2010).
Public should be included in all decision making including national and international policies. Good research is essential for the successful public health interventions. WHO also emphasises the importance of people to participate in health developments to increase control of and improve their own health (cited in Bunton, 2008)
ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES
ICT plays a major role in the promotion of healthy lifestyle and the enhancement of public health initiatives. The Royal Institute of Public health (2003) reveals that around 125 million Americans visit websites for health information every year. Currently there are around one billion websites providing health information, where there was only one website in 1991.
HEALTH AS AUTONOMY
People have the right to be healthy. The patient should be treated as a whole who can make contributions to health. Each and every person should be respected and involved in the decision making process for their own treatment preferences. According to Gillen (cited in Azetsop et al 2010) respect should be given to peoples autonomous views.
Illich (cited in Clarke, 2010) again states that health is a personal task, which people must be free to pursue autonomously. He also addresses that doctors and other health care members contribute to ill health by taking over people’s responsibility for health.
Development of complementary therapies shows peoples’ dissatisfaction with invasive and impersonal medicine.
Biomedicine has a vital role in the modern scientific medicine, but its major disadvantages include iatrogenesis and lack of social support. No major inventions were made in the 20th century. Social, environmental and psychological factors were considered as the health indicators. People became more aware of their own and family’s health and participated in decision making regarding treatment options. The marked improvement in life expectancy has its major contribution from social factors that of 17% from medical factors. Considering the evidences the author thinks the basics of health and illness can only be defined in social terms and plays a major role in the improvement of health status, whereas biomedicine has its own part in the scientific and curative aspect of health and illness.
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