Healthcare

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2. What challenges to Yvonne’s health and wellbeing did she face following the medical diagnosis? What was the impact of sociocultural expectations on her wellbeing?

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3. What did help Yvonne?

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4. Taking a social model perspective, what might you want to better understand in order to improve the health and wellbeing of Yvonne and other people in a similar situation?

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Part C

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Now, reflect on your experience of learning from this audio clip. What differences did you find using audio rather than text and video resources? What skills did you apply?

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View discussion - Part C

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The social model of health attempts to integrate social structures and people’s bodily existence in the world. It goes beyond the body to address the social, economic and environmental determinants of health. As you have learned, female reproductive health is one example where the social model offers a useful perspective. The biomedical model would consider reproductive health in relation to the body and reproductive roles, whereas the social model starts from the perspective of the social, cultural and economic, as well as equality issues. You will read more about the social model of health next.

1.2 Understanding the social model of health

The social model of health is so broad that it can be difficult to get a sense of it as a whole, but at the heart of it is a person’s social context. As you have already touched on, a person’s social context can bring a wide range of factors to bear on their health and wellbeing.

In the next activity, you will read a text that describes the social model of health in detail.

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Activity 3.2: The social model of health

Allow about 1 hour 15 minutes

Part A

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Read Reading 3 ‘The social model of health’ by Yuill et al. (2010a), either as a webpage or PDF .

Note: when you read references to social class, take it that social class one represents ‘Higher managerial, administrative and professional occupations’. Social class five represents ‘Semi-routine and routine occupations’ (Office for National Statistics, 2010).

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Part B

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Summarise the main points of each of the following six sections of Reading 3.

1. Individual health is enabled or inhibited by social context.

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2. The body is simultaneously social, psychological and biological.

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3. Health is cultural.

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4. Biomedicine and medical science is something – but not everything.

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5. Health is political.

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6. Other voices matter.

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Part C

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1. Consider the physical and emotional metaphors discussed by Yuill et al. (2010a) in the section ‘Health is cultural’. Can you think of any other cultural metaphors that apply to the topic of health, wellbeing or illness? You may like to record your ideas in the box below.

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Provide your answer...

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2. Share your metaphors with your K219 peers on Twitter. Use the hashtag #OUK219metaphors. If you do not wish to post on Twitter, share your tweets on the module forum instead.

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3. Re-tweet one tweet you particularly like or think is interesting. When you do so, add a comment, for example, about why you like it. Doing this will help you create a conversation and you will find that talking through your ideas with others on Twitter is a key way of challenging your opinions and introducing you to new ideas. If you do not wish to do so on Twitter, comment on a tweet you particularly like or find interesting posted by another student on the module forum instead.

Remember, if you do not wish to create a Twitter account, you can still follow the conversation by searching for the hashtags using Twitter’s search page .

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View transcript - Audio 3.2 Mental health: mad or sad

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As you work through this learning guide, you will continue to think about the range of voices that can be brought to bear on people’s understandings of health and wellbeing.

1.3 Lay perspectives matter

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We all need a voice

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An understanding of health and illness is not purely the privileged knowledge of the medical profession, many sophisticated, complex but different understandings of health are also held by ordinary people; and this knowledge is termed ‘lay’.

Chris Yuill, Iain Crinson and Eilidh Duncan (2010b, p. 98)

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It is important that professionals consider an individual’s understanding of their health when responding to their health issues. The biomedical approach has traditionally viewed lay perspectives as inferior, driven by personal opinion, and they often deviate from the scientific and technical knowledge of experts. Traditionally therefore, under a biomedical approach, the voices of patients, their carers and other non-experts are viewed as less important than professional voices, knowledge and expertise.

By contrast, the social model of health suggests that a good understanding of lay knowledge can usefully inform expert knowledge. Rather than reinforce the distinctions between these forms of knowledge, academics following the social model argue that understanding how people construct and interpret health and wellbeing is vital to maintaining and supporting health (Yuill et al., 2010a).

People construct and interpret their own health and wellbeing based on all aspects of their personal identity and background. Cultural psychiatrist Dr Micol Ascoli believes that being able to work with people’s own cultural interpretations of mental illness is crucial to supporting their recovery. She spoke to broadcaster and psychologist Claudia Hammond about her work at Newham Centre for Mental Health in London. In the next activity, you will consider Dr Ascoli’s approach to her work and hear from one of her patients, Angela.

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Activity 3.3: Working with lay perspectives of illness

Allow about 40 minutes

Part A

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Listen to the following audio, which is an extract from the radio programme ‘Mental health: mad or sad’.

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Audio 3.2 Mental health: mad or sad

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Part B

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What lay perspectives on bipolar disorder are discussed in the audio? How did the speakers report the lay perspectives as being helpful? Add your findings below.

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Lay perspective described by:	How this knowledge can help:
Angela	Provide your answer...	Provide your answer...
Dr Ascoli	Provide your answer...	Provide your answer...

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View transcript - Video 3.1 The menopause: I was taken aback by how crazy I felt

Part C

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Think about a condition – a disease or disorder – that you or perhaps someone close to you has. What are your own beliefs about the causes of this condition? Are there any aspects of your background that helped to shape these beliefs?

Reflect on these questions and then answer the following polls about your beliefs regarding causes of the condition. Your vote will be anonymous and once you have submitted it you will be able to see how the other students on K219 have responded.

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View discussion - Part C

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Whatever a person’s beliefs about health are, it is likely they will have been shaped by many factors that are specific to that person and may not always reflect wider assumptions held by society more broadly, or indeed fit with the biomedical model. This, however, does not diminish their potential value for understanding health and wellbeing because they will affect health behaviours, personal resilience and the ability to achieve health goals. Furthermore, sometimes the experiences and views of a particular group can have a profound and powerful effect on the views of wider society and alter the professional knowledge base as a result.

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To sum up ...

This section has explored the need for a social model of health and explained how a person’s social environment can have a profound impact on their health and wellbeing. Listening to lay perspectives can help clinicians support patients better.

In the next section, you will consider the impact of social and cultural contexts on health and wellbeing by exploring issues around women’s health.

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2 Social change for health and wellbeing?

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A women’s rights protest

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There is no such thing as a single-issue struggle because we do not live single-issue lives.

Audre Lorde (2007, p. 138)

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The social model highlights how important it is to recognise that health is intricately related to the society in which people live. The model also allows for the influence of culture on how illness is understood, treated and avoided. It follows that social policy can have a fundamental impact on people’s health and wellbeing. But more than that, social policies affect access to healthcare services, as well as the type of services that are available.

Some social and cultural practices and beliefs can undermine the resilience and aspirations of people in a way that has very little to do with the underlying biomedical issue they may be facing. All of this can negatively influence an individual’s sense of wellbeing and recovery in ways that are equal in impact to the physiological or mechanical fix that might come through a biomedical intervention. This section addresses the impact of social and cultural context on health and wellbeing by exploring issues around women’s health.

There are two activities and they will take around two hours 15 minutes of study time.

2.1 Movements in women’s health

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Women protesting about reproductive rights

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Women need not always keep their mouths shut and their wombs open.

Emma Goldman, 1916 (see Anderson, 1970, p. 62)

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Social movements have a history of challenging the dominance of biomedicine and developing their own focus on health issues. An important impact of the work of social movements relates to how they have liberated what people already instinctively know about health and illness and legitimised this lay knowledge as a counter to biomedical opinions and priorities.

For example, one of the ways in which the women’s health movement has attempted to gain more control for women over their bodies and their health is by sharing experiences and information about health matters among women. The Boston Women’s Health Book Collective, which began in 1969, has been influential in this area. The work of the women in Boston influenced the development of women’s healthcare worldwide. Many of the early aims of the women’s health movement were to challenge doctors’ control over reproductive technology and to claim women’s right to control their own bodies and develop self-help groups and feminist education (Doyal and Elston, 1986).

Although these concerns still exist, many women’s organisations now focus on disadvantaged groups. The Women’s Health and Equality Consortium (WHEC, 2017), for example, has championed the needs of homeless women, migrant women, women with dementia, older women, and girls and young women in health policy. The consortium links these groups with issues such as economic disadvantage, caring roles and gender-based violence (WHEC, 2011), claiming that ‘Women are the main “shock absorbers” of poverty of households’ (p. 1).

Research can also disadvantage women if it does not accurately represent them. Alice Dan, a researcher who has been writing about women’s health since the 1970s, suggested that women’s experiences are ‘distorted in the research’ and that ‘Women’s lives exist in the gaps between the traditional disciplines’ (Dan, 2013, p. 164). Menstruation and menopause are salient examples of issues tightly bound with the social context, and which can fall between disciplines. Journalist Allison Pearson shared her experience of menopause for the BBC’s Woman’s Hour. In the next activity, you will hear her account and a discussion about ‘period poverty’. You will consider how a social model of health could help to change things for the better.

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Activity 3.4: ‘Women’s issues’

Allow about 45 minutes

Part A

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Watch Video 3.1 and listen to Audio 3.3, in which the menopause and period poverty are discussed. Then complete the exercises below.

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Video 3.1 The menopause: I was taken aback by how crazy I felt

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Audio 3.3 Why ‘period poverty’ is a bigger problem than we think

View transcript - Audio 3.3 Why ‘period poverty’ is a bigger problem than we think

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Part B

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Bearing in mind the concerns identified by the women’s health movement and the ‘gaps between disciplines’ highlighted by Alice Dan above, identify issues raised in Video 3.1 and Audio 3.3 and propose solutions to them from the perspective of the social model. Add your notes to the table and, when you are finished, rank the rows to show the importance of the evidence and solutions you have identified.

Don’t worry about the practicalities – that is for the policymakers. Simply get your ideas down. This is good practice for developing your skills in academic argument, because to complete the table below you will need to match ‘evidence’ (or, in this case, the issues raised in personal accounts) with a ‘claim’ of some sort (in this case, your proposed solution, e.g. ‘Health professionals need better education on the menopause’).

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View description - There are many things and ideas associated with intersectionality, as suggested by ...

Part C

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If you are interested in these and similar topics, why not follow some women’s organisations on Twitter, for example:

· Wellbeing of Women: @WellbeingofWmen

· WomensResourceCentre: @whywomen

If you don’t have a Twitter account, you could explore their Twitter feeds instead by clicking on the links provided above.

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Over time, the women’s health movement became rather fragmented as differences based on race and ethnicity, class, sexual orientation and age emerged. A recent report has highlighted, for example, the health inequalities faced by black and ethnic minority women in the UK, and their particular vulnerability to cuts to public services (Hall et al., 2017). Despite this fragmentation, women’s voices are stronger and more diverse than ever. In essence, women’s movements have helped to assert the need for ‘lay’ knowledge to be taken seriously when considering responses to health-related issues.

The women’s movement has also influenced ideas around intersectionality, which claims that social categories interact to create unique forms of identity, ability and vulnerability. You will explore this next.

2.2 Intersectionality and the social model

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There are many things and ideas associated with intersectionality, as suggested by this word cloud

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People can identify with, and be assigned to, a range of social categories such as ‘race’, ‘gender’ and ‘class’. Moreover, their social context carries strong implications for their health. An intersectional approach argues that social categories are not simply additive – race + gender + class – but that categories intersect and interact with each other. Intersectionality is an exciting concept that opens new ways of thinking and talking about the health and wellbeing of individuals. Although its main objective is the pursuit of social justice, it can work alongside the social model in addressing diversity and inequities in health (Reid et al., 2012).

In the next activity you will read about intersectionality and develop your awareness of how academic texts are constructed.

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Activity 3.5: Intersectionality – a Canadian perspective

Allow about 1 hour 30 minutes

Part A

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Read an extract from the academic paper ‘ Intersectionality and the determinants of health: a Canadian perspective ’ by Hankivsky and Christoffersen (2008).

You should read the following parts:

· The abstract.

· From the header ‘Toward a better understanding of the determinants of health’ to the end of the paragraph beginning ‘Thirdly, an intersectional perspective does not simply add social categories …’.

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Part B

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Consider how the extract is constructed and how the authors build their argument. Read it carefully all the way through first and then work through the questions below.

1. According to the abstract, what were the authors’ purposes for writing this paper? Summarise this in your own words.

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2. What is the argument that Hankivsky and Christoffersen build in the extract?

To answer this question you will need to do two things. First, make notes on the key points of each paragraph in the extract, aiming to capture the sequence of the argument. Then, read back through your notes and summarise their argument in a couple of sentences.

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3. How do Hankivsky and Christoffersen use signposting in the extract to progress their argument?

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· The Sage Dictionary of Health and Society

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4. Are there any concepts or themes mentioned in the extract that you already know about? Notice how the authors apply them. Are there any concepts you don’t understand? Make a note of these and look them up in a dictionary such as this one:

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View description - The UK political landscape in 2017 showing how constituencies voted in the General ...

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To sum up ...

This section has discussed how women’s movements and the concept of intersectionality can illustrate the power of a social model for promoting better health and wellbeing. Although the women’s movement and other disadvantaged groups cannot claim a single unified voice, it has certainly exposed the myriad ways that political, economic and social factors affect lives – and this is an area where there is still much to be done.

In the next section, you will further explore the other ways in which politics can influence the health and wellbeing of us all.

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3 Health is political

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The UK political landscape in 2017 showing how constituencies voted in the General Election

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In this section, you will focus on the relationship between the policies of government departments, such as the Department for Work and Pensions, and health and wellbeing. In particular, you will examine how the social model of health demonstrates the influence of policymakers’ decisions on health and wellbeing in various ways, both obvious and not so obvious.

There are three activities and they will take approximately 1 hour 45 minutes of study time.

3.1 Social inequalities in health and wellbeing

It is increasingly recognised that good health results from factors broader than those typically embraced by the biomedical model. Perhaps the most important challenge to biomedicine comes from the impact of social inequalities on health.

The impact of social inequality is forcefully described in a short video that you will watch in the next activity.

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Activity 3.6: Failings in social welfare provision

Allow about 15 minutes

Part A

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Laura Pidcock is a Labour MP. In October 2017 she talked to journalist Owen Jones about the Department for Work and Pensions (DWP).

Watch the following video, which is a short clip from their conversation.

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Video 3.2 Labour MP Laura Pidcock talks to Owen Jones: ‘The DWP has caused fear and terror’

View transcript - Video 3.2 Labour MP Laura Pidcock talks to Owen Jones: ‘The DWP has caused fear and ...

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Part B

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1. What are Laura Pidcock’s criticisms of DWP’s welfare policy?

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2. What are the effects on health and wellbeing according to Laura Pidcock?

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Mental distress of the sort you learned about in Activity 3.6 can, over time, lead to a range of physical and mental illnesses. Although the biomedical model, and the scientific perspective it brought to our understanding of health and illness, has improved life expectancy greatly over the past few centuries, the most impressive reductions in death rates have actually come from improvements in much wider environmental and social factors. The following quote from McKeown summarises this:

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The improvement of health during the past three centuries was due essentially to provision of food, protection from hazards, and limitation of numbers; medical science and services made an important contribution to the control of hazards but only a limited one through immunisation and therapy.

(McKeown, 1976, p. 178)

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The point made by McKeown back in 1976 has been consistently reinforced in a range of major reports into inequalities in health, each of which has stressed that inequalities in health are caused by socioeconomic circumstances. These include Inequalities in Health: Report of a Research Working Group (Black et al., 1982); The Acheson Report (1998) and The Marmot Review (2010). You will consider the work of Michael Marmot later in this section, but first you will look at some statistics.

3.2 What do the statistics show?

When lobbying for policy changes, it is important to draw on strong evidence. Laura Pidcock, in the previous activity, presented anecdotes from her personal experience, which leaves her argument open to claims of bias and a lack of objectivity. However, to persuade a government or an organisation to make policy changes, there needs to be statistical evidence showing the size and extent of an issue. It also helps if there are also research findings about possible solutions. Moreover, changes observed over time indicate trends and could offer clues about what is causing these trends, especially if there has been a prominent socioeconomic or policy change. Personal experience is also important of course, and is often represented in government reports as cases that illustrate the personal impact of an issue.

In the next activity, you will explore some health statistics that are in the public domain, and that are used by public bodies for developing policy.

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Activity 3.7: Finding and handling health data

Allow about 1 hour

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You are now going to use the Wider Determinants of Health tool.

· Go to the tool on the Public Health England website.

· On the homepage, under ‘Area type’ select ‘Region’. Under ‘Area’ select a region to focus on.

· In the green ribbon, select either ‘Trends’ or ‘Compare areas’.

· Explore the data under ‘Marmot indicators’ and ‘Health outcomes’ (tabs in the grey ribbon running along the top of the page). Look carefully at all the information on each page – there is a lot to take in at first.

· Find a chart that demonstrates either differences over time (a trend) or differences between regions. Download it, and file it where you can easily retrieve it. Write a sentence or two describing what the figures show. (You may wish to use the box below.)

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Provide your answer...

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When you have finished return here to continue with the learning guide.

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View description - Figure 3.3 Number of years from birth spent with disability, persons by neighbourhood ...

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3.3 Fair society, healthy lives

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Sir Michael Marmot giving a keynote speech

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One of the most outspoken and respected academics on the subject of social determinants of health is Professor Sir Michael Marmot. His population-based work studying data similar to what you looked at in the last activity has revealed clear links between health and socioeconomic status. You may have looked at the ‘Marmot indicators’, which were named after him. In 2010 in a report entitled Fair Society, Healthy Lives he explained, for example, that although life expectancy for both men and women had improved, the gap between rich and poor in ‘disability-free life expectancy’ had widened. In other words, people were living longer with some form of impairment and the poor were increasingly more likely to live with impairments as they age.

Marmot (2010) presented graphs that showed clear health gradients between the richest and poorest throughout England. For example, Figure 3.3 shows the gradient in years spent with disability, according to levels of deprivation, from figures gathered in 2001. Each of the green dots represents a person.

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Figure 3.3 Number of years from birth spent with disability, persons by neighbourhood income level, England 2001 (Source: Marmot, 2010, p. 51)

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Although biomedicine may have enabled the population as a whole to live longer, people living in disadvantaged circumstances are more likely to suffer ill health. It is also true that inequality in populations is bad for everyone’s health. Marmot explained it like this:

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The social gradient in health describes a graded association between an individual’s position on the social hierarchy and health: the lower the socioeconomic position of an individual, the worse their health. The fact that the social gradient extends from the highest echelons of society to the lowest suggests that everyone is affected to a greater or lesser extent by the social determinants of health.

(Marmot, 2018, p. 186)

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Marmot concluded that in order to tackle health inequalities the solutions are not to be found within biomedicine. Instead, the solutions are social.

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Marmot’s six social solutions to health inequalities

1. Give every child the best start in life.

2. Enable all children, young people and adults to maximise their capabilities and have control over their lives.

3. Create fair employment and good work for all.

4. Ensure a healthy standard of living for all.

5. Create and develop healthy and sustainable places and communities.

6. Strengthen the role and impact of ill health prevention.

(Marmot, 2010, p. 15)

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In the next activity you will watch an extract from a keynote speech in which Marmot presented his latest findings about the conditions that make people sick.

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Activity 3.8: Addressing the determinants of health

Allow about 30 minutes

Part A

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Watch the following presentation given by Marmot in 2017.

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Video 3.3 Sir Michael Marmot: Prioritising and developing further action on reducing the social gradient in health

View transcript - Video 3.3 Sir Michael Marmot: Prioritising and developing further action on reducing ...

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You may find it helpful to stop the video when each chart appears to give you time to study it closely.

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Part B

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1. According to Marmot, what is the trend in mortality in the USA and what lessons can the UK learn from it?

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2. How did Marmot demonstrate the effects of austerity on health in the UK?

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View transcript - Video 3.4 Social model of disability

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To sum up ...

This section has considered the relationship between government policy and health and wellbeing. Government policy can clearly affect life expectancy, and the health and wellbeing of some members of UK society are particularly vulnerable to policy changes.

Disabled people are often disadvantaged, and therefore rely on government policies to enable change that will improve their access to Marmot’s six themes for addressing the social determinants of health. In the next section, you will consider the experiences of disabled people.

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4 Disability and the social model

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Campaigning for better access to public transport

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Perhaps one of the most important consequences of the challenge to the dominance of professional voices and the biomedical model has been the development of the social model of disability. Viewing disability through the lens of a social model has inspired disabled people to push for positive change in society, as well as helping a professional audience to think differently about disability. You will explore this using video resources and social media, as well as through considering academic perspectives.

There are three activities and they will take about 1 hour 35 minutes of study time.

4.1 Living the social model of disability

In parallel with the differences between the social and biomedical models of health, the social and biomedical models take contrasting perspectives on the subject of disability. The Equality Act 2010, which provides a legal framework for ensuring the rights of disabled people, assumes that:

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(6)(1) A person (P) has a disability if –

· (a) P has a physical or mental impairment, and

· (b) the impairment has a substantial and long-term adverse effect on P’s ability to carry out normal day-to-day activities.

(Great Britain. Equality Act 2010, s.6(1))

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The biomedical model considers a person’s impairment to be the cause of any difficulties in day-to-day activities. By contrast, the social model assumes that a person’s social environment is the primary disabling factor. This could be anything from the built environment to the prevailing attitudes in a community.

Under the biomedical model, solutions to a person’s impairment tend to focus on what needs ‘fixing’ in and around them. People with disabilities are expected to have lower aspirations in life because of their impairments. Conversely, under the social model people seek to dismantle environmental, attitudinal and policy barriers that prevent people with disabilities participating in society and achieving their full potential (Scope, 2017). In the next activity, you will consider further the benefits of the social model approach to disabled people.

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Activity 3.9: Social and biomedical models in action

Allow about 30 minutes

Part A

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Watch the following two videos about the social model of disability.

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Video 3.4 Social model of disability

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Video 3.5 What is the social model of disability?

View transcript - Video 3.5 What is the social model of disability?

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Part B

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Think about how the social model is an improvement over the biomedical model for people with disabilities. Make notes under the headings:

Achieving their full potential

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Having meaningful relationships

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Playing an active part in the world

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Part C

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Using your notes from Part B to help you, drag and drop the descriptions to complete each table showing how the biomedical and social models differ in their approach to helping people with disabilities in everyday situations.

1. Click on the following link complete the first table:

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2. Click on the link below to complete the second table:

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View discussion - Part C

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The social model has clear benefits for helping disabled people access information, go about their daily lives and engage in society with a sense of equal opportunity. The model has helped to drive policy changes through the Equality Act 2010. It is interesting, though, that the definition of disability in the Equality Act seems to arise from a biomedical model, where the focus is on a person with an impairment. Nevertheless, even a social interpretation of disability needs to assume the presence of impairment (or at least a notable biological difference), even if the source of disability is social (Priestley, 2005). Next, you will consider what further developments are required.

4.2 Living with disability

There is universal agreement that disabled people are a deprived sector of the community and that in a civilised society government interventions should be initiated to improve their situation. Every survey, census or research project undertaken in diverse countries and cultures around the world has confirmed the existence of this deprivation.

Discussions on social media can offer a good indication of how such issues affect people’s lives. In the next activity, you will find examples on Twitter of the problems disabled people face, and consider whether they regard their disability from a biomedical or social model approach to policy or practice.

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Activity 3.10: Exploring disability issues

Allow about 45 minutes

Part A

Start of Question

Search Twitter either by signing in or using the search box for tweets about disability and its links with the biomedical or social models.

Think about the people and organisations appearing in your results.

· Is anyone disseminating research?

· Does anyone seem to be networking for personal reasons?

· Is there a particular style or composition of tweet that catches your attention?

In the content of the tweets, make a note of anything that indicates an emphasis on a person’s impairment and what they can’t do, or whether the focus is on a disabling social or physical environment. Are they concerned, perhaps, with policy or public attitudes?

You might need to try out different combinations of terms before you find useful results. Remember to use inverted commas around phrases to ensure the whole phrase is searched rather than individual words. For example, a search for references to the social model with inverted commas (‘social model’) will give you very different results than searching without (social model). You can also search using specific hashtags, e.g. #SocialModel. This strategy would narrow your results to only tweets that have included the hashtag. Hashtags tend to be used by people who want their tweets on a certain topic to be found quickly and conveniently, especially if they are taking part in an ongoing conversation.

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Part B

Start of Question

Spend some time composing your own tweets.

There are many things you could tweet about. For example, you might want to further disseminate some research you think is informative and valuable, or you might want to support an individual in their efforts to network or influence others in some way. You may want to tweet about your own experience. Make sure that you write something original that you have learned about so far through your studies, particularly in relation to this part of K219. In writing your tweet, think about what you’d like to communicate to your K219 peers as well as to the wider Twitter community.

Finally, remember to include the hashtag #OUK219disability.

Post your tweet on Twitter or the module forum . Remember to return to Twitter and the module forum to check the tweets from your peers who use these hashtags. You may want to continue the conversation by commenting and re-tweeting.

End of Question

End of Activity

4.3 The social model re-examined

Finally, as with all models, the social and biomedical models of disability may offer a framework for understanding the issues and provide solutions, but they cannot fully account for the complexity of real life. All models have their weaknesses. Polarised views rarely reflect people’s experiences. In the next activity, you will read an academic paper published in the journal Disability & Society in which the author Jonathan Levitt asks searching questions about the future for the social model.

Start of Activity

Activity 3.11: Considering the way forward for the social model

Allow about 1 hour 20 minutes

Part A

Start of Question

Read Jonathan Levitt’s (2017) paper on ‘ Exploring how the social model of disability can be re-invigorated: in response to Mike Oliver ’.

Scan the headings in the article to get a sense of the content. Then read closely, highlighting his main points about the social model. You can do this by making your own notes, or click through to the PDF version of the paper and use a highlighter tool.

End of Question

View discussion - Part A

Part B

Start of Question

Based on your reading of Levitt’s article, answer the following questions.

1. True or false? In the abstract, Levitt outlines the content of his article.

End of Question

True

False

Start of Question

2. Complete the following sentence.

In the abstract, Levitt explains that he identified his five questions through:

End of Question

… examining websites.

… talking to disabled people.

… examining the published literature.

… an online questionnaire.

Start of Question

3. Complete the following sentence.

In the introduction, Levitt explains that:

End of Question

… he wants to see a conclusion to the debate on the social model.

… the scope and relationships of the social model reflect the social circumstances of current times.

… attitudes to disability in the UK have changed slightly over the last 30 years.

… he wants to widen the debate on the focus of the social model.

Start of Question

4. True or false? Levitt considers himself to be a disabled person.

End of Question

True

False

Start of Question

5. True or false? Levitt is writing in a third-person voice.

End of Question

True

False

Start of Question

6. At the beginning of the section on ‘Scope of the social model’, Levitt quotes directly from Oliver’s 2013 paper to reinforce his claim that the social model:

End of Question

… was originally aimed at dismantling barriers.

… unnecessarily restricted people’s participation in society.

… can change society’s understanding of disability.

… did not recognise people’s impairments.

Start of Question

7. True or false? According to Levitt, Oliver said that the social model of disability could be a political tool.

End of Question

True

False

Start of Question

8. Under ‘Relationship with other models of disability’, why does Levitt want to change the wording in descriptions of the social model of disability by Bolt (2005), Forber-Pratt and Aragon (2013) and the World Health Organization (2017)? Tick all the options that apply.

End of Question

He wants to encourage use of the social model by people who regard disability as not only being shaped by society.

Emancipatory research does not need to be associated with the social model.

‘Society’ is not the only cause of disablement.

Start of Question

9. Complete the sentences shown below by selecting the appropriate word from each drop-down list.

Start of Media Content

Interactive content is not available in this format.

End of Media Content

End of Question

Start of Question

10. True or false? In Levitt’s conclusion, he claims that the 1995 Disability Discrimination Act led to an improvement in the levels of poverty for disabled people.

End of Question

True

False

End of Activity

Start of Study Note

To sum up ...

This section has shown how the concept of disability provides a unique perspective on the idea of a social model. The social model of disability has facilitated the removal of barriers to participation for disabled people. Having a framework for understanding and discussing complex health, wellbeing and equality issues allows people to work through problems in a structured way.

In the next section, you will begin to think through how you will tackle the next TMA.

End of Study Note

5 Getting ready for TMA 02

Start of Figure

Are you ready for your next assignment?

End of Figure

You are shortly going to be writing an assignment for TMA 02, which will be your first academic essay in K219. It will draw on the content of Learning Guides 1–4. Now is therefore a good time to think about some of the skills you will need to develop for writing at Level 2. This is a continuous process – people never stop developing their writing skills, even experienced writers. Regularly creating a space to think about writing will help to keep it uppermost in your mind. It can also help you to identify any weaknesses and find ways of tackling them.

There are two activities and they will take approximately 1 hour 55 minutes of study time.

5.1 Writing for Level 2 assignments

The essays you write during the course of your studies will draw on and reflect the skills you are developing. At Level 2, these skills are becoming more sophisticated than at Level 1. This is not something you should particularly worry about achieving if you carry out the learning guide activities and give yourself time to develop your writing when you are working on the assignments. Thinking about these things earlier rather than later is therefore worthwhile.

During this module, and through the assignments, you will be demonstrating that you can:

· effectively communicate information, arguments and analysis in a variety of forms to specialist and non-specialist audiences

· show you are familiar with and understand a range of the essential theories, principles or concepts, and that you are aware of major issues in a topic

· gather, evaluate and critically analyse information and ideas relating to your subject.

These are skills expected of every student in the UK studying at this level. In writing this module, the K219 team has created opportunities for you to develop them.

The next two activities focus on the first point – in Activity 3.13 you will explore how to form an argument, but first you will consider what makes communication effective.

Start of Activity

Activity 3.12: Writing effectively

Allow about 40 minutes

Start of Question

Before you start, take a look at your next assignment to get an idea of what it is asking you to do.

End of Question

Start of Question

1. Think back to essays you have written on previous modules you have studied. Write down two or three challenges you find in writing essays. If you are returning to study after many years, you may want to base your notes on your recent writing experiences in a different context, for example, at work, or writing letters/emails to your child’s school. There’s no need to dig out old essays – if anything stands out in your memory, that’s good enough at this point!

End of Question

Provide your answer...

· Using an appropriate writing style

Start of Question

2. Go to the OU Help Centre’s (2014) article on ‘Writing for University’ and work through the following sections:

· Dividing your work into paragraphs

· Using linking words

End of Question

Start of Question

3. Does the advice in ‘Writing for University’ address any of the challenges you listed in Question 1? Write down any suggestions the article provided in the box below.

End of Question

Provide your answer...

Start of Question

4. If ‘Writing for University’ did not address any of the challenges you identified, investigate the study resources available through the OU Help Centre and write down advice that will help you. Make notes in the box.

End of Question

Provide your answer...

End of Activity

What are the most effective ways of structuring an assignment and using appropriate language in order to present a convincing argument to a particular audience? This is the focus of Section 5.2.

5.2 Forming an argument

Academic essays require you to form an argument. This does not mean, of course, that you need to be argumentative! When constructing an argument, you are making a case for a particular point of view on a subject. The assignment question may ask you to consider different sides of a debate or explain why people behave as they do in particular circumstances. You may need to decide which theory is best at leading people to a better understanding of an issue or solve a problem. Whatever the task, you will need to draw together the appropriate evidence and structure a narrative that leads your reader through a series of steps in your thinking. You need to show your tutor that you understand the subject, and that you know the difference between personal opinion, academic opinion, facts, examples and statistics.

In the following activity you will access a selection of resources that will help you think about how to organise your essay and how to use language cautiously. Good organisation and signposting will help your argument to flow. Careful use of language, including ‘hedging’, will help you show that you understand the limits of the evidence you are drawing on. Does the evidence make you ‘certain’ about something, or is it only ‘likely’ to be the case? Most of the time, academic writing cannot claim certainty. You need to recognise when your personal experience is colouring your interpretations of the evidence. And so on.

Start of Activity

Activity 3.13: Exploring the language and structure of argument

Allow about 1 hour 15 minutes

Start of Question

In Part A of this activity you will work through three resources that are available to all students on The Open University’s website. The resources, which are linked to below, provide information and ideas for structuring and organising your writing, and how to use cautious language. In Part B you will then consider how you might use what you have learned in TMA 02 .

End of Question

Part A

Start of Question

1. Click on the link to Developing academic English: structure of text. Organising the response in an appropriate way . Watch the video to the end and skim read the page it sits on.

2. Click on the link for Developing academic English: academic writing style. Using language appropriate to both audience and task . Watch the video to the end, and remember to skim read the page it sits on.

3. Click on the link to Hedging or using language cautiously and complete the steps. Note that this resource is more involved than those you explored in Questions 1 and 2 and will take about 20–30 minutes to work through.

End of Question

Part B

Start of Question

Make some notes here about how you might use the knowledge you have gained in Part A in your next TMA. Read the assignment and begin to formulate your approach to using evidence well in your argument.

End of Question

Provide your answer...

End of Activity

Start of Study Note

To sum up ...

This section has introduced some important academic skills that you will need to develop as you progress through the module. Planning ahead can help you to make opportunities to practise your skills.

End of Study Note

Conclusion

This learning guide started with the following key questions:

Start of Study Note

· What are the challenges to biomedicine from a social model approach?

· How does the social model add to our understanding of the health and wellbeing of individuals?

· How has social change impacted on how we understand and approach illness, health and wellbeing?

End of Study Note

This learning guide considered challenges to biomedicine from a social model approach and discussed how the social model can aid our understanding of the health and wellbeing of individuals. By looking at our recent past, it also showed some of the developments resulting from social and policy changes.

The social model approach is based on the assumption that however much you may try to ‘treat the individual’ or tailor personalised services, at the end of the day these individuals are embedded in social worlds, relationships, power structures and cultural norms that will always impact on their personal experience of health and illness and their resilience for maintaining wellbeing.

Perhaps the key challenges from a social model approach to biomedicine is the recognition that health is cultural and political, and as a result a range of voices must be heard in relation to it. This has been illustrated by the emergence of a range of challenges to biomedicine from social and community action, for example, through the growth of activity that focuses on women’s and disabled people’s health concerns, and issues of inequality.

Although biomedicine might appear to be under threat from a number of areas, it remains dominant. It continues to play a key role in all our lives and within service provision, but it does need to be responsive to external challenges, and this is why a social model approach has been so important.

Additional selected readings

If you wish to undertake independent study this week, you may find the following resources useful:

· Corry, D. (2018) Hearing Women’s Voices: Why Women? 2018, London, Women’s Resource Centre [Online]. Available at https://thewomensresourcecentre.org.uk/wp-content/uploads/WRC-Report-2018-Full-Report-FINAL-4th-June.pdf (Accessed 9 July 2018).

· The Institute of Heath Equity website: http://www.instituteofhealthequity.org/home

· The benefits section of the Department for Work and Pensions’ website: https://www.gov.uk/browse/benefits

References

Acheson, D. (1998) Independent Inquiry into Inequalities in Health Report, London, The Stationary Office [Online]. Available at Error! Hyperlink reference not valid. (Accessed 17 July 2018).

Anderson, G. (1995) The 22 Non-Negotiable Laws of Wellness: Feel, Think, and Live Better Than You Ever Thought Possible, New York, HarperSanFrancisco.

Anderson, M. (1970) The Little Review Anthology, New York, Horizon Press.

Black D., Morris J., Smith C. and Townsend P. (1980) Inequalities In Health: Report Of A Research Working Group, London, Department of Health and Social Security. Available at Error! Hyperlink reference not valid. (Accessed 17 July 2018).

Dahlgren, G. and Whitehead, M. (2007) European Strategies for Tackling Social Inequities in Health: Levelling Up Part 2, Copenhagen, WHO Regional office for Europe [Online]. Available at Error! Hyperlink reference not valid. (Accessed 11 June 2018).

Dan, A. J. (2013) ‘Emancipatory research: then and now’, Sex Roles, vol. 68, no. 1, pp. 163−167.

Doyal, L. and Elston, M. A. (1986) ‘Women, health and medicine’, in Beechy, V. and Whitelegg, E. (eds) Women in Britain Today, Milton Keynes, Open University Press, pp. 173–208.

Great Britain. Equality Act 2010: Elizabeth II. Chapter 15 (2010) London, The Stationary Office, [Online]. Available at Error! Hyperlink reference not valid. (Accessed 9 July 2018).

Hall, S-M., McIntosh, K., Neitzert, E., Pottinger, L., Sandhu, K., Stephenson, M.-A., Reed, H. and Taylor, L. (2017) Intersecting Inequalities: The Impact of Austerity on Black and Minority Ethnic Women in the UK [Online]. Available at Error! Hyperlink reference not valid. (Accessed 9 July 2018).

Hankivsky, O. and Christoffersen, A. (2008) ‘Intersectionality and the determinants of health: a Canadian perspective’, Critical Public Health, vol. 18, no. 3, pp. 271-283 [Online]. Available at Error! Hyperlink reference not valid. (Accessed 17 July).

Henderson, R. (2014) Holistic Medicine [Online]. Available at Error! Hyperlink reference not valid. (Accessed 9 July 2018).

Iacobucci, G. (2018) ‘Medical model of care needs updating, say experts’, BMJ, vol. 360, no. k1034 [Online]. Available at Error! Hyperlink reference not valid. (Accessed 9 July 2018).

Levitt, J. (2017) ‘Exploring how the social model of disability can be re-invigorated: in response to Mike Oliver’ Disability & Society, vol. 32, no. 4, pp. 589-594 [Online]. Available at Error! Hyperlink reference not valid. (Accessed 17 July 2018).

Lorde, A. (2007) ‘Learning from the 60s’, in Sister Outsider: Essays & Speeches by Audre Lorde, Berkeley, CA, Crossing Press.

Marmot, M. (2010) Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post-2010, London, The Marmot Review [Online]. Available at Error! Hyperlink reference not valid. (Accessed 17 July 2018).

Marmot, M. (2018) ‘Inclusion health: addressing the causes of the causes’, The Lancet, vol. 391, no. 10117, pp. 186−188.

McKeown, T. (1976) The Role of Medicine: Dream, Mirage or Nemesis?, London, Nuffield Provincial Hospitals Trust.

Office for National Statistics (2010) SOC2010 Volume 3: The National Statistics Socio-economic Classification (NS-SEC rebased on SOC2010) [Online]. Available at Error! Hyperlink reference not valid. (Accessed 9 July 2018).

Parliamentary and Health Service Ombudsman (n.d.) Introduction to the Social and Medical Models of Disability [Online]. Available at Error! Hyperlink reference not valid. (Accessed 9 July 2018).

Priestley, M. (2005) ‘Disability and social inequalities’, in Romero, M. and Margolis, E. (eds) Blackwell Companion to Social Inequalities, Blackwell Publishing, Blackwell Reference Online [Online]. Available at Error! Hyperlink reference not valid. (Accessed 9 July 2018).

Public Health England (2018) Wider Determinants of Health [Online]. Available at Error! Hyperlink reference not valid. (Accessed 6 September 2018).

Reid, C., Pederson, A. and Dupéré, S. (2012) ‘Addressing diversity and inequities in health promotion: the implications of intersectional theory’, in Rootman, I., Dupéré, S., Pederson, A. and O’Neill, M. (eds) Health Promotion in Canada: Critical Perspectives on Practice, 3rd edn, Toronto, Canadian Scholars’ Press Inc.

Scope (2017) The Social Model of Disability [Online]. Available at Error! Hyperlink reference not valid. (Accessed 9 July 2018).

The Open University (2014) Writing for University: Using An Appropriate Writing Style [Online]. Available at Error! Hyperlink reference not valid. (Accessed 17 July 2018).

Women’s Health and Equality Consortium (WHEC) (2011) Why Women’s Health? [Online]. Available at Error! Hyperlink reference not valid. (Accessed 9 July 2018).

Women’s Health and Equality Consortium (WHEC) (2017) Publications [Online]. Available at Error! Hyperlink reference not valid. (Accessed 9 July 2018).

Yuill, C., Crinson, I. and Duncan, E. (2010a) ‘The social model of health’, in SAGE Key Concepts Series: Key Concepts in Health Studies [Online], London, Sage UK. Available at Error! Hyperlink reference not valid. (Accessed 17 July 2018).

Yuill, C., Crinson, I. and Duncan, E. (2010b) ‘Lay knowledge and illness attribution’, in SAGE Key Concepts Series: Key Concepts in Health Studies [Online], London, Sage UK. Available at Error! Hyperlink reference not valid. (Accessed 9 July 2018).

Acknowledgements

Grateful acknowledgement is made to the following sources:

Text

Activity 3.2: Reading 3, Yuill, C., Crinson, I., Duncan, E., Key Concepts in Health Studies, pp. 5-30. Copyright © 2010 by Chris Yuill, Iain Crinston, and Eilidh Duncan. Reprinted by permission of SAGE Publications, Ltd. 5. Copy of Licensee’s Publication. Licensee will provide Licensor with a copy of Licensee’s Publication

Illustrations

Introduction: © SolStock / iStock / Getty Images

Section 1: © kemalbas / iStock / GettyImages

Section 1.1: Dahlgren G, Whitehead M. (1991). Policies and Strategies to Promote Social Equity in Health. Stockholm, Sweden: Institute for Futures Studies.

Section 1.3: © filadendron / iStock / Getty Images

Section 2: © W. Breeze / Hulton Archive / Getty Images / Universal Images Group

Section 2.1: © Authenticated News / Getty Images / Universal Images Group

Section 3: © BBC News

Section 3.3 (photo): © Professor Michael Marmot

Section 4: © John Birdsall / John Birdsall Social Issues Photo Library / Press Association Images / Universal Images Group

Section 5: © monkeybusinessimages / iStock / Getty Images

Videos and audios

Activity 3.1: © BBC

Activity 3.3: © BBC

Activity 3.4 (Video 3.1): © BBC

Activity 3.4 (Audio 3.3): © BBC

Activity 3.6: Copyright Guardian News & Media 2018

Activity 3.8: © The King's Fund

Activity 3.9 (Video 3.4): © Courtesy of Shape Arts

Activity 3.9 (Video 3.5): © Used with permission from Scope

Every effort has been made to contact copyright holders. If any have been inadvertently overlooked the publishers will be pleased to make the necessary arrangements at the first opportunity.

Activity 3.1: Wellbeing beyond the reach of biomedicine

Part B

Discussion

Yvonne received ‘infertility investigations’ that concluded she was unable to conceive. There was no particular cause found, which meant that there was no detectable ‘defect’ to treat medically.

Activity 3.1: Wellbeing beyond the reach of biomedicine

Part

Discussion

Yvonne experienced many challenges, starting with the difficulties of talking to her family when she was experiencing shock and grief. She was grieving when there was no visible loss. I thought she also talked a lot about how being diagnosed with unexplained infertility challenged the beliefs and cultural expectations of her and her family, and this further had an impact on her wellbeing:

· There was an expectation that there should be a way of fixing her infertility (perhaps referencing a biomedical approach).

· Yvonne experienced shame in not being able to live up to the expectation that she would one day become a mum. Being from an immigrant family increased the pressure of this expectation. Perhaps the pressure of having to be positive about the situation was the worst element.

Part B

Discussion

You may have found it refreshing to hear a medical practitioner so deeply engaged with lay perspectives. Here are my notes in response to the questions.

Start of Table

Lay perspective described by:

How this knowledge can help:

Angela

She talked about her upbringing and religious background, particularly with regards to believing in ‘the spirit’.

She believes that her bipolar disorder is a gift from God.

Medication is also a ‘gift’.

She is able to make sense of manic and depressive episodes by linking to passages in the Bible.

The way she views medication helps it to fit with her belief system.

Dr Ascoli

A patient’s desired outcomes from medical treatment can be quite different from the medical outcomes that doctors normally work towards.

Some groups can have different cultural constructs that cause professionals confusion. For example, some ethnic minorities may refer to ‘brothers and sisters’ in a completely different sense to that normally applied in western societies.

Recognising that medical models are also culturally determined, and that taking lay views of health seriously helps patients.

Better communication between healthcare professionals and service users can broaden understanding and ‘fill the gap’.

End of Table

Activity 3.3: Working with lay perspectives of illness

Part C

Discussion

It is useful to think carefully about the origins of your own lay perspectives on health and wellbeing. Even if you are a healthcare professional, there will be areas of health of which you do not have a complete, expert grasp. If there are differences between who you would share your belief with, it might indicate that you and/or they are adhering to social pressures to behave in a certain way and hold certain beliefs. You may find it helpful to think a little more about the social pressures you feel. Are they, for example, related to the nature of the illness, or a concern about being judged? Your experience might be that not all healthcare professionals are as receptive to lay beliefs as Dr Ascoli.

Back to - Part C

Activity 3.4: ‘Women’s issues’

Part B

Discussion

The few personal accounts presented in the video and clip are good illustrations of the issues. However, if you really wanted to make a case for social change, you would clearly need more, and stronger, evidence, to represent the extent of the issue (how many people are affected, and the depth of the personal impact) and perhaps some economic statistics. I hope, however, that this activity has helped you see how the social model can be applied to some of the health and wellbeing issues women face these days.

Start of Table

Issue	Proposed social model solutions
Menopause is the butt of jokes. Men’s blood is acceptable in films, whereas women’s blood is thought to be ‘disgusting’. A woman can experience discrimination in the workplace because of menopausal symptoms.	Menopause needs more recognition and understanding in society generally, and especially in the workplace. Education in schools and workplaces would help. People need access to better information – in workplaces, on the internet, as well as in health centres.
Women are commonly misdiagnosed with depression rather than as going through the menopause.	Health professionals need better education about the menopause.
Girls growing up in poor families in Leeds do not have access to sanitary protection products.	Eliminate poverty in the first place. Provide families living in poverty with free access to sanitary products.
A teacher can be in a good position to recognise menstruation issues in schoolgirls.	Provide all girls with free sanitary-protection products in schools. Educate teachers on the issues of period poverty.

End of Table

Activity 3.5: Intersectionality – a Canadian perspective

Part B

Discussion

The authors were using the theoretical paradigm of intersectionality to explore the causes of illness and disease and how they interact to produce health inequalities.

Activity 3.5: Intersectionality – a Canadian perspective

Part

Discussion

This is how my notes summarising the extract turned out:

· Efforts are being made to analyse the state of health, and the social determinants of health, in Canada.

· There have been calls for theoretical innovations in the areas of population health and health determinants.

· A range of conceptual work has begun responding to these calls from the perspective of social science, particularly in looking at social inclusion/exclusion. However, there are criticisms that this work has not gone far enough. Intersectionality is a promising alternative approach.

· The authors discuss the history of intersectionality and its theoretical origins, and its increasing popularity in health research and policy. Despite growing interest, there is still much to learn about intersectionality and health.

· Intersectionality is uniquely placed to shed new light on how we might eliminate health disparities when faced with health inequality, but researchers and policymakers need to be systematic about it. There are three reasons why intersectionality has value.

· First, one cannot assume that one determinant of health takes priority over any other, and people need to accept that the social determinants of health are multidimensional and overlapping.

Discussion

Here are a few of Laura’s criticisms:

· The processes for claiming benefits are degrading.

· Assessors such as those for Personal Independent Payments do not have the appropriate expertise.

· The welfare system is built on the assumption that people are liars.

· Policymakers are out of touch with the people affected by their policies.

Activity 3.6: Failings in social welfare provision

Part

Discussion

Effects on health and wellbeing include benefit claimants experiencing anxiety, fear and terror that they will lose their homes and not have enough money to eat. Some break down in surgeries when describing their situation; some have also expressed suicidal thoughts.

View description - Figure 3.2 Mortality rate from causes considered preventable in the East Midlands ...

Activity 3.7: Finding and handling health data

Part

Discussion

You could have downloaded an overview chart or something with less detail. I found a chart under ‘Health outcomes’ (Figure 3.2), which shows that for the East Midlands, although the rate of preventable deaths is decreasing, the rate of decrease was levelling off between 2013 and 2015. This would indicate that progress on ill-health prevention is slowing down.

Start of Figure

Figure 3.2 Mortality rate from causes considered preventable in the East Midlands region (Source: Public Health England, 2018)

End of Figure

It is important to develop skills in gathering and using statistical information, and this tool on Public Health England’s website stores a wealth of up-to-date data. It is disappointing that other parts of the UK are not similarly catered for!

Activity 3.8: Addressing the determinants of health

Part B

Discussion

According to Marmot, the mortality rate is increasing in the USA. Top causes of mortality are poisoning due to drugs and alcohol; suicide; chronic liver disease (mainly caused by alcohol). Economic distress led people to take their own lives, drink alcohol and be statistically more likely to vote for Donald Trump. Marmot considered the USA to be a sign of what could happen in the UK if austerity measures, leading to economic distress, continued.

Activity 3.8: Addressing the determinants of health

Part

Discussion

Marmot demonstrated that economic distress is also evident in the UK and has increased following the recent austerity measures. Lower spending evidently has affected the quality of life for older people, although more work is needed to find out whether it will shorten lives. The North-South gap continues to widen, which indicates the effects of industrial policy in the UK. He also demonstrated that government policy, focused on improving the lives of the poorest in society, can help to close the life expectancy gap.

Activity 3.9: Social and biomedical models in action

Discussion

Take another look at the abstract if you weren’t sure about the answer.

Activity 3.11: Considering the way forward for the social model

Part

Discussion

Levitt states this in the introduction.

Activity 3.11: Considering the way forward for the social model

Part

Discussion

This statement is true – Levitt makes this clear in the introduction.

Activity 3.11: Considering the way forward for the social model

Part

Discussion

Levitt is writing in the first person, making it clear that he is expressing his own opinions in addition to drawing on the work of others to provide evidence.