How useful is a ‘social approach’ in explaining differences in health amongst different social groups?

Introduced in the 1980s (Smith and Goldblatt,2004,p.70), social explanations emphasize the impact of socio-economic structures to create and maintain differences in health amongst different social groups.

In order to assess the usefulness of this approach, this essay will first outline the model’s main characteristics. Then, by focusing on ‘The Black Report’ and ‘The health divide’ analyses, the discussion will move on to identify the model’s strengths and weaknesses, also taking into account how some of the latter have been dealt by alternative approaches, such as the ‘complementary’ model and ‘the New Public Health’.

Social explanations focus on the overall health of society rather than individual health, by assessing and comparing the health of its populations, categorized according to socio-economic factors such as occupation, gender and ethnicity. Health is usually measured using statistical methods: data is collected for a representative set of health indicators (i.e.death rates) then figures are compared in order to find patterns which may suggest links between social groups and their social environments. Statistical data is sometimes backed up by qualitative evidence.

Two government reports on UK society, ‘The Black Report’ (1980) and ‘The health divide’ (1992), are examples of how the social approach could be employed. These reports included the mortality, morbidity and life expectancy statistics according to social class for 1978-79 and 1992.

Although improvements in health within each class were recorded between the two periods, class differential remained steady, with people on lower incomes still suffering from poorer health than those in the higher levels of the socio-economic scale, despite access to health services was made free since 1948 (Smith and Goldblatt,2004,p.52-54).

In contrast with restricting health and illness to the realm of human biology, as the dominant view of the time suggested drawing on the medical model, the reports highlighted the main strength of the social approach: its inclusion of socio-economic factors in explaining health differences.

By looking for associations between health variations and socio-economic factors, social explanations can also identify which of these structural forces might have the strongest impact on the health of different groups, thus directing governments in promoting targeted polices. For instance, the authors of the reports focused on material resources, such as poor housing, suggesting that a more equal distribution of resources was needed. This was also confirmed by a later experiment where relocating families from low income to richer areas resulted in an improvement in their health (Smith and Goldblatt, 2004, p.52-55).

The large use of statistical surveys to gather evidence, is also another strength of the social model, as claims can be backed up by the higher degree of objectivity and reliability accorded to such scientific techniques(Smith and Goldblatt,2004,p.71).

However, the social model does have some limitations .

Firstly, its highly focused analysis of social structures leads other structural forces, such as biological factors, to be overlooked. For instance, the association between high mortality rates and manual unskilled groups in the two reports was interpreted as the influence of low class position on health. Yet, it can be argued that if these groups had a higher percentage of old people, the impact of social class would have been less clear (Goldblatt,2004,p.30).

Secondly, the social approach fails to take into account the impact that individual agency has on health. Even if cultural explanations (Goldbatt,2004,p.31) within the social approach recognize a role to lifestyle, the individuals’ position in society may prevent them from making healthy choices, for example if economically unattainable (Smith and Goldblatt,2004,p.67). However agency can be exercised through collective action, by tackling socio-economic inequalities at the level of national policies (Smith and Goldblatt, 2004,p.70).

Another criticism to the social approach regards the danger of creating statistical artifacts. Even though evidence is gathered through scientific techniques, the acts of observation and data interpretation always involve a subjective component. Thus, an opposite interpretation of the two reports could suggest the influence of health on class position on the grounds that physical weakness may prevent access to the top jobs. Besides, figures may not represent accurately individuals’ mobility within the labour market nor they account for the class shrinkage occurred in the last years (Goldbatt, 2004,p.31-32).

For a more comprehensive explanation of health differences amongst different social groups, the Complementary and The New Public Health models could be considered.

Both approaches, whilst acknowledging the importance of biological and social factors, focus much more on individuals’ agency and prevention. Thus, they can help explaining health differences within and between social groups that can be related to individuals’ choices and clarify what control we have on our health.

The complementary model embraces an holistic view that sees body and mind as interlinked. Thus psychological and emotional factors are acknowledged and the responsibility on our health as well as the capacity for treatment is placed upon us. However, the effectiveness of the approach is hard to demonstrate because it relies on individual experience rather than scientific observation (Smith and Goldblatt, 2004, p.58-60).

By contrast, The New Public Health’s focus on lifestyle and risk assessment benefits from using techniques based on the scientific approach (Smith and Goldblatt, 2004, p.63-69). It also focuses on health promotion and prevention not only within the individual but also in the communities. For example, whilst the social approach could suggest that better housing conditions are needed in order to improve the health of people living in depressed areas, the New Public Health could highlight the need to facilitate people in making healthy choices, for example by offering health resources, such as sport facilities, in those areas (Smith and Goldblatt, 2004, p. 62).

In conclusion, the usefulness of the social model in explaining health differences amongst social groups draws upon its ability to address the impact that socio-economic factors have on health differences, using rigorous, albeit not entirely objective, evidence, to support its analyses.

However, the model’s primary focus on social structures risks to overlook other factors that influence health, with particular disregard to individual agency.

Thus, alternative, more rounded approaches, such as the complementary model and the New Public Health, could also be considered for a better understanding of health issues.

References

Goldblatt, D. (2004) DD121 Workbook 2, Milton Keynes, 2nd edn. The Open University.

Smith, B. and Goldblatt, D., (2004) ‘Whose health is it anyway?’, in Hinchliffe, S. and Woodward, K. (ed.) The Natural and the Social: Uncertainty, Risk, Change, London, 2nd edn. The Open University.