Biomedical versus social models of health

1. 1. Overview — Why Two Models Exist

Health is a complex, multidimensional concept. The World Health Organization (WHO) defines health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" (1948). This definition immediately signals that no single framework can capture everything that shapes a person's health.

Historically, Western medicine developed around the biomedical model, which dominated from the 19th century through much of the 20th century. As chronic, lifestyle-related, and socially determined diseases became the leading causes of death and disability in Australia, health researchers, governments, and the WHO recognised that clinical medicine alone could not address these challenges. This gave rise to the social model of health and, practically, to health promotion frameworks such as the Ottawa Charter for Health Promotion (1986).

In the NSW HSC, you must understand each model on its own terms, then evaluate them — meaning you must weigh strengths against limitations and apply each to real Australian health issues. Focus Area 1 (Health in an Australian and global context) makes this comparison a core examination area.

2. 2. The Biomedical Model — Definition, Principles and Application

The biomedical model views health primarily as the absence of disease, injury, or disability. It is grounded in the biological sciences — anatomy, physiology, pathology, and pharmacology — and frames health problems as having identifiable physical or biochemical causes that can be diagnosed, treated, and ideally cured.

Core principles of the biomedical model:

• Reductionism: complex health problems are broken down into specific, measurable biological components (e.g., identifying a pathogen, measuring blood glucose, imaging a tumour).
• Individual focus: the unit of intervention is the patient; success is measured by the patient's clinical recovery.
• Curative emphasis: the primary goal is to restore the body to a prior state of biological function through surgery, medication, or clinical procedures.
• Scientific objectivity: diagnosis and treatment rely on empirical, evidence-based protocols (e.g., randomised controlled trials, clinical guidelines).
• Expert authority: trained medical professionals hold specialised knowledge; the patient is largely a passive recipient of care.

Applied example — Type 2 diabetes under the biomedical model: A patient presents with elevated HbA1c (glycated haemoglobin). The biomedical response involves blood tests, diagnosis, prescription of metformin or insulin, dietary advice from a dietitian, and monitoring of blood glucose. The model successfully manages the disease at the individual level and prevents acute complications such as diabetic ketoacidosis or organ damage. This is genuinely life-saving and represents the model's greatest strength.

Strengths of the biomedical model:

• Highly effective for acute, infectious, and surgically treatable conditions — antibiotics for bacterial infections, vaccines for communicable diseases, surgery for traumatic injuries.
• Produces measurable, relatively rapid outcomes that can be evaluated and compared.
• Underpins Australia's world-class hospital and primary care system, including Medicare-funded GP visits, public hospital care, and the Pharmaceutical Benefits Scheme (PBS).
• Evidence base is robust and continuously updated through clinical research.

Limitations of the biomedical model:

• Does not address why a person became sick — it treats the disease, not the conditions that produced it (social determinants such as poverty, poor housing, unemployment).
• Largely passive for the patient; does not build individual or community capacity to manage their own health.
• Expensive at scale — treating chronic disease after the fact costs far more than preventing it upstream.
• Ineffective for conditions rooted in behaviour, environment, or inequality — cardiovascular disease, obesity, mental illness, and substance use disorders are poorly addressed by clinical medicine alone.
• Historically marginalised Indigenous healing practices and community-based health knowledge, contributing to distrust of mainstream health services among Aboriginal and Torres Strait Islander communities.

3. 3. The Social Model of Health — Definition, Principles and Application

The social model of health broadens the definition of health to encompass the full range of social, economic, cultural, and environmental conditions that influence health outcomes across populations. Rather than asking "what disease does this person have?" it asks "what conditions in society are making people sick?"

Core principles of the social model:

• Determinants of health: health is shaped by a complex interplay of biological, social, economic, cultural, and environmental factors — collectively called determinants of health. The social model prioritises the social determinants: income, education, employment, housing, social support networks, and access to services.
• Population focus: instead of treating one patient at a time, the social model aims to improve health across whole communities and populations.
• Equity orientation: the model explicitly addresses health inequalities, recognising that disadvantaged groups bear a disproportionate burden of poor health.
• Empowerment and participation: individuals and communities are active agents in their own health; the model builds capacity rather than dependency.
• Intersectoral collaboration: improving health requires action beyond the health sector — education, housing, employment, transport, and urban planning all contribute.

Applied example — Type 2 diabetes under the social model: Rather than only treating diagnosed patients, the social model asks why Type 2 diabetes rates are three times higher among Aboriginal and Torres Strait Islander Australians, and significantly higher among people in lower-income brackets. Interventions include: community-controlled health services delivering culturally safe care; urban planning policies that increase access to fresh food in remote and low-income areas; school-based nutrition programs; income support policies that allow families to afford healthy food; and public awareness campaigns that normalise physical activity. These strategies address the conditions that produce high diabetes rates, rather than managing the disease once it has developed.

Strengths of the social model:

• Addresses root causes — by tackling income inequality, poor education, and inadequate housing, the social model has the potential to prevent large numbers of people from becoming sick in the first place.
• More equitable — explicitly designed to reduce health disparities between socioeconomic, cultural, geographic, and demographic groups.
• Sustainable long-term impact — population-level improvements in education and income yield health benefits across generations.
• Aligns with the WHO definition of health and the Ottawa Charter action areas, providing a globally recognised policy framework.
• Better suited to the leading causes of death in Australia (cardiovascular disease, cancer, mental health conditions, diabetes) which are predominantly chronic and lifestyle/socially influenced.

Limitations of the social model:

• Long implementation timelines — structural changes to income, education, and housing take years or decades to translate into measurable health improvements; this makes it politically difficult to sustain commitment.
• Requires significant intersectoral collaboration and political will, which is not always available.
• Outcomes are harder to measure and attribute than a clinical recovery; this makes evaluation and funding justification more complex.
• Cannot replace acute clinical care — a person having a heart attack needs biomedical intervention immediately, regardless of the social determinants that contributed to their condition.
• Resource-intensive to implement at scale, particularly in remote or underserved regions of Australia.

4. 4. The Ottawa Charter — Social Model in Practice

The Ottawa Charter for Health Promotion (WHO, 1986) is the most important practical expression of the social model in the HSC curriculum. It was developed in response to the growing recognition that biomedical approaches alone were insufficient to address the global burden of chronic and preventable disease.

The Ottawa Charter identifies five action areas for health promotion:

• Build healthy public policy: embedding health considerations into legislation and policy across all sectors (e.g., plain packaging laws for tobacco, sugar taxes, minimum wage increases).
• Create supportive environments: shaping the social, physical, and economic environments in which people live and work to support healthy choices (e.g., smoke-free workplaces, cycling infrastructure, safe play spaces).
• Strengthen community action: empowering communities to set their own health priorities and develop their own solutions (e.g., Aboriginal Community Controlled Health Organisations — ACCHOs).
• Develop personal skills: building individual health literacy, knowledge, and capacity through education and skill development (e.g., school-based programs on nutrition, mental health first aid).
• Reorient health services: shifting the focus of health systems beyond clinical cure toward prevention, health promotion, and community-based care.

The Ottawa Charter also identifies three strategies that underpin all action areas: advocate (champion health as a human right and social value), enable (reduce health inequities by ensuring equal access to resources), and mediate (coordinate action across sectors and stakeholders).

Worked example — Tobacco control in Australia: Australia's success in reducing smoking rates (from over 30% of adults in the 1980s to under 12% today) is a landmark case study in applying Ottawa Charter principles. Policy actions included: plain packaging legislation (healthy public policy), smoke-free indoor environments (supportive environments), Quit Victoria community campaigns (community action), school-based health education (personal skills), and GP brief intervention programs (reorienting health services). No single biomedical intervention achieved this; it required coordinated social model action across all five areas.

5. 5. Comparing the Two Models — A Direct Evaluation

When HSC examiners ask you to evaluate both models, they expect you to discuss strengths and limitations in the context of Australian health, not just describe what each model is. The following table provides a structured comparison:

Key evaluative point for extended responses: Neither model is sufficient on its own. The most effective health systems — and the most compelling HSC responses — recognise that Australia needs both: biomedical infrastructure to treat illness when it occurs, and social model strategies to address the determinants that cause illness in the first place. The Australian Government's National Preventive Health Strategy (2021–2030) explicitly integrates both, calling for investment in prevention (social model) while maintaining strong clinical services (biomedical).

6. 6. Application to Indigenous Health — A Critical Australian Case Study

The health gap between Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians is one of the most significant and persistent health inequities in the country. This case study illustrates precisely why the biomedical model alone is insufficient and why the social model is essential.

The biomedical model's contribution: Increased access to GP services, PBS medicines, hospital care, and disease-specific programs (e.g., dialysis for chronic kidney disease, cardiac surgery) has improved outcomes for individual patients. The expansion of the Medical Outreach — Indigenous Chronic Disease Program and the Close the Gap PBS co-payment measure are biomedical initiatives that have had measurable impact.

Why the biomedical model is insufficient: Aboriginal and Torres Strait Islander Australians die, on average, 8–9 years earlier than non-Indigenous Australians (AIHW, Australian Indigenous Health InfoNet). The causes are overwhelmingly social determinants: lower household income, higher unemployment, poorer housing conditions (overcrowding, lack of running water in remote communities), lower educational attainment, higher rates of incarceration, intergenerational trauma from colonial dispossession and the Stolen Generations, and systemic racism in health service delivery. No amount of clinical treatment addresses these upstream causes.

The social model's response: The Closing the Gap framework (2008, revised 2020 with full co-design with Aboriginal and Torres Strait Islander peoples) applies social model principles directly. Targets include: closing the life expectancy gap by 2031; halving the gap in child mortality by 2031; achieving educational parity; and ensuring 65% of Aboriginal and Torres Strait Islander people live in areas of high or moderate wellbeing by 2031. The model of Aboriginal Community Controlled Health Organisations (ACCHOs) — of which there are over 140 across Australia — embodies the social model: they are governed by Aboriginal people, deliver culturally safe care, address social needs (housing referrals, legal aid, employment support) alongside clinical care, and strengthen community action as per the Ottawa Charter.

Evaluative conclusion for this case study: The Indigenous health gap demonstrates that biomedical interventions are necessary but not sufficient. Genuine improvement requires sustained social model investment — addressing housing, education, income, and self-determination — alongside high-quality, culturally safe clinical services.

7. 7. Integrating the Models — The Modern Australian Approach

Contemporary Australian health policy increasingly reflects an integrated approach that draws on both the biomedical and social models. Understanding this integration is important for top-band HSC responses, which go beyond describing each model in isolation to explain how they interact in practice.

Examples of integration in Australian health policy:

• National Preventive Health Strategy 2021–2030: The Australian Government's strategy explicitly prioritises prevention (social model action areas: healthy environments, health literacy, social determinants) while maintaining investment in clinical care (biomedical). It identifies priority populations including Aboriginal and Torres Strait Islander peoples, people in rural and remote areas, and people with lower socioeconomic status.
• Primary Health Networks (PHNs): 31 PHNs across Australia commission both clinical services (GP care, mental health services — biomedical) and community health promotion programs (social model) based on local population health needs.
• Chronic Disease Management Plans (CDMPs): Under Medicare, GPs can create CDMPs that coordinate allied health services (dietitians, physiotherapists, psychologists) — a hybrid model that treats the biological disease while addressing behavioural and social factors.
• Mental Health Reform: Australia's National Mental Health and Suicide Prevention Plan acknowledges that mental health is shaped by housing security, social connection, trauma, and economic participation (social determinants) and calls for intersectoral action alongside clinical care.

Examination application tip: When writing extended responses, a sophisticated answer will evaluate each model, identify the health issue or context being examined, and then argue for an integrated approach — explicitly using terminology such as social determinants of health, Ottawa Charter action areas, health equity, and upstream interventions. Avoid the trap of treating the two models as mutually exclusive competitors; the best responses show how they are complementary.