What is the Social Model of Care? An In-Depth Guide

First conceptualized by disability rights activists in the late 20th century, what is the social model of care? This approach asserts that disability and poor health are largely caused by external, societal barriers rather than solely by an individual's physical or mental impairment. It represents a paradigm shift, moving the focus from 'fixing' the person to changing the environment to be more inclusive and supportive.

Quick Summary

The social model of care frames health and disability as a product of societal and environmental factors, not just individual impairments. It emphasizes removing systemic barriers and promoting inclusion to improve well-being, contrasting sharply with the traditional medical model's focus on clinical intervention.

Key Points

• Shift in Perspective: The social model frames disability and poor health as issues caused by societal barriers, not an individual’s impairment alone.

• Empowerment and Control: It promotes person-centered care and empowers individuals to have greater control and self-determination over their own lives and health.

• Address Social Determinants: The model is closely tied to addressing social determinants of health, recognizing that factors like housing, education, and employment significantly impact well-being.

• Societal Responsibility: It places the responsibility on society to remove barriers and create inclusive environments, shifting the focus from 'fixing' the person to 'fixing' the system.

• Contrast with Medical Model: The social model contrasts with the medical model, which views disability as a problem residing within the individual to be treated or cured.

• Promotes Equality: Ultimately, the social model is a framework for social justice that advocates for full participation and equality for everyone, regardless of their physical or mental abilities.

Origins and Core Philosophy

The social model of care grew out of the disability rights movement of the 1960s and 1970s, as activists challenged the prevailing view that a person's impairment was the problem. This traditional, or 'medical,' model framed disability as an individual tragedy to be cured or managed by medical professionals. In contrast, the social model made a critical distinction between impairment—the physical or mental condition—and disability—the restriction of activity caused by an unaccommodating society.

Disabled activists, notably Mike Oliver, argued that societal structures, attitudes, and policies were the true source of a person's exclusion and oppression. For instance, a person who uses a wheelchair is not disabled by their impairment but by a building that lacks a ramp. By shifting the problem from the individual to the environment, the social model reframed disability as a political and human rights issue rather than a purely medical one. This philosophy emphasizes collective responsibility for creating an inclusive society, empowering individuals, and fostering self-determination.

Key Components of the Social Model

Central to this model are several interconnected principles that guide practice across various care settings:

• Focus on Social and Environmental Barriers: Instead of focusing on an individual's deficits, the model identifies and seeks to remove systemic barriers. These can be physical (e.g., lack of ramps), attitudinal (e.g., prejudice or low expectations), or informational (e.g., lack of braille or audio resources).
• Person-Centered Approach: Care is designed around the individual's history, preferences, and social context, not just their diagnosis. It prioritizes autonomy and respects the individual's inherent value and lived experience.
• Emphasis on Empowerment: The model promotes self-advocacy and supports individuals in having control over their own health and lives. This collaborative relationship shifts the dynamic from patient dependency to a partnership.
• Advocacy for Social Justice: The social model sees health equity as a fundamental goal. By addressing inequalities stemming from factors like economic status, education, and community context, it works to create a fairer society where everyone has a chance to thrive.
• Distinction Between Impairment and Disability: This core tenet recognizes that while an individual may have a specific impairment, the disability they experience is a result of societal actions, policies, and structures. The solution, therefore, lies in social change, not in curing the impairment.

Social Model vs. Medical Model: A Comparison

To better understand the social model, it is helpful to compare it directly with the traditional medical model. While the two are not mutually exclusive and can sometimes complement each other, their fundamental approaches differ significantly.

Feature	Medical Model of Care	Social Model of Care
Focus	Individual pathology, deficit, or illness.	Societal and environmental barriers.
Problem	The individual's impairment needs to be fixed or cured.	An unaccommodating society causes disability.
Solution	Medical intervention, treatment, or therapy.	Social change, advocacy, and removal of barriers.
Patient's Role	Passive recipient of expert knowledge.	Active participant in their own care and decisions.
Language	Uses clinical, diagnostic terminology to describe conditions.	Emphasizes person-first language and empowerment.
Goal	Restore 'normal' functioning or mitigate symptoms.	Promote inclusion, independence, and quality of life.
Attitude	Can foster pity and low expectations.	Cultivates acceptance, equality, and dignity.

The Role of Social Determinants of Health

The social model of care is closely aligned with the concept of Social Determinants of Health (SDOH). These are the conditions in which people are born, grow, work, live, and age that affect their health outcomes. The social model provides a framework for understanding how these determinants create health disparities and how to address them.

Examples of SDOH include:

• Economic Stability: Income, employment, and debt can all impact a person's ability to afford nutritious food, housing, and healthcare.
• Neighborhood and Built Environment: Access to safe housing, clean air, green spaces, and reliable transportation all influence health.
• Social and Community Context: Support systems, social inclusion, and experiences with discrimination play a significant role in well-being.
• Education Access and Quality: Higher educational attainment often correlates with better health outcomes and greater access to stable employment.
• Healthcare Access and Quality: The availability of and accessibility to quality healthcare services impacts overall health.

The social model of care advocates for interventions that target these broader social factors, recognizing that treating a health issue in isolation, without addressing its environmental and social context, often leads to poor long-term outcomes. For example, a clinic following the social model might not only treat a person's asthma but also connect them with housing assistance if they are living in a poorly ventilated, mold-infested home.

Implementation and Practical Examples

Implementing the social model requires a multi-sectoral approach that involves healthcare providers, policymakers, community organizations, and individuals. Instead of asking, "What's wrong with this person?" the social model prompts, "What are the societal barriers preventing this person from living their life fully?".

Consider these practical examples of the social model in action:

1. Workplace Accessibility: An employee who is hearing impaired might be excluded from meetings conducted only through spoken word. A social model solution provides sign language interpreters and written communication, removing the barrier and enabling full participation.
2. Dementia Care: Instead of focusing solely on the clinical aspects of cognitive decline, the social model of dementia care emphasizes a person's history, social life, and emotional needs. It seeks to create an engaging and supportive environment that focuses on remaining abilities rather than losses, leading to a higher quality of life.
3. Housing Support: A person with a chronic illness struggles to manage their health due to unstable housing. A care provider, guided by the social model, would connect the individual with social services to secure stable housing, understanding that addressing this social determinant is critical for improving their health.
4. Mental Health Services: Rather than only prescribing medication for anxiety, a social model approach would explore the underlying causes, such as financial stress, housing instability, or social isolation. Treatment plans would then incorporate therapy alongside referrals to community resources that address these root social issues.

Conclusion

The social model of care represents a fundamental shift in how we approach health and disability. By moving the focus from individual pathology to societal barriers, it champions a more holistic, person-centered, and just approach to well-being. It was a revolutionary idea born from the disability rights movement and has since become a powerful tool for social change. By emphasizing the removal of environmental, attitudinal, and systemic obstacles, this model not only improves individual health outcomes but also actively works towards creating a more equitable and inclusive society for all. It reminds us that disability is not an individual's fate, but a social responsibility to overcome.

References

• UPIAS (1976). The Fundamental Principles of Disability. https://disability-studies.leeds.ac.uk/wp-content/uploads/sites/40/library/Barnes-implementing-the-social-model-chapter-2.pdf

A Broader Perspective on Care

The social model of care is a framework that re-evaluates the core assumptions of health and disability. It originated with the disability rights movement, which sought to distinguish between a person's impairment and the systemic barriers that create 'disability'. This powerful distinction shifts the responsibility for inclusion from the individual to society, promoting universal design and the removal of physical, attitudinal, and communication barriers. Its principles extend far beyond disability, applying to wider concepts of health equity and social justice by addressing underlying social determinants of health, such as housing, employment, and community context. In practice, this leads to person-centered and empowering approaches that enable individuals to have control over their lives and participate fully in society.

The Three Models of Disability

While the medical and social models are the most prominent, disability scholars and advocates have also identified a third perspective, the moral model.

• Moral Model: This is the oldest model, viewing disability as a sign of spiritual, moral, or karmic consequence. It can result in stigma and shame, or, conversely, a sense of honor or divine purpose. While less dominant today, its influence can still be seen in subtle societal attitudes and depictions in media.
• Medical Model: Views disability as an individual's medical problem or deficit that requires treatment to be cured or managed. It is often associated with a clinical, expert-driven approach that can disempower the individual.
• Social Model: Posits that disability is the result of societal barriers and systemic oppression, rather than the impairment itself. It is a civil rights approach that promotes social change, accessibility, and empowerment.

The Biopsychosocial Model

Recognizing the limitations of relying exclusively on one model, some healthcare professionals and academics advocate for the biopsychosocial model. This approach attempts to integrate elements of all three models by acknowledging the complex interplay between biological factors (impairment), psychological factors (individual experience and coping), and social factors (environmental barriers and social support). It offers a more nuanced, holistic perspective, recognizing that while societal change is crucial, individual medical and psychological needs are also important. However, some disability activists remain cautious that the focus on individual factors in this blended model could inadvertently shift the emphasis back towards the medical perspective.

Frequently Asked Questions

How does the social model of care differ from the medical model?

The social model of care differs from the medical model by shifting the focus of the 'problem' from the individual's impairment to societal barriers. The medical model sees disability as a defect within the individual that needs to be fixed or cured, while the social model argues that people are disabled by an unaccommodating society.

What are some practical examples of the social model of care?

Practical examples include installing ramps and curb cuts for wheelchair users, providing communication resources like sign language interpreters for deaf individuals, and ensuring accessible housing options. In a dementia care setting, it means focusing on a person's history and social needs rather than just their cognitive decline.

What is the social model of care for dementia?

The social model of dementia care focuses on understanding the person with dementia within the context of their social circumstances and biography. It prioritizes creating a supportive and engaging environment that emphasizes remaining abilities and independence, rather than focusing solely on cognitive loss.

How does the social model define 'disability'?

Within the social model, 'disability' is defined as the disadvantage or restriction of activity imposed on a person by an unaccommodating society. It distinguishes this from 'impairment,' which is the physical or mental condition itself.

Why is the social model important for health equity?

The social model is important for health equity because it highlights how social determinants of health—like economic stability, access to education, and neighborhood environments—contribute to health disparities. By addressing these systemic issues, it works to create a fairer society where everyone has a chance at good health.

Who developed the social model of disability?

The social model was developed by disabled people and disability rights activists. Its origins can be traced to the UK in the 1970s, with activist and sociologist Mike Oliver popularizing the term in the 1980s.

Can the social model and medical model work together?

Yes, many organizations integrate aspects of both the social and medical models. While they have fundamentally different starting points, using both can offer a comprehensive, holistic approach. The social model focuses on inclusion and empowerment, while the medical model can still provide valuable insights into clinical aspects and treatments for managing impairments.