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Scholars have attempted to theorise the question of how social factors affect well-being and access to healthcare in different ways. This paper will describe examples of scenarios that demonstrate social inequalities in health status. It will consider these in the context of how some sociological models have attempted to account for them. This essay shall also discuss the pros and cons of these theories.


‘Health status’ is a concept that expresses in both quantitative and qualitative terms, a range of parameters related to physical, mental, and emotional well-being. To put it simply, health status is an expression of whether an individual is healthy or not.  It may be determined by subjective measures (such as when a person states that he or she ‘feels’ well and healthy) and by objective measures (such as the presence or absence of clinically significant illness).

Throughout history, and across human cultures, there have existed a variety of approaches towards conceptualising health and disease and these have served as the bases for the many different systems of medicine and therapeutic practices known to humans as a species. What may be seen as a form of illness in one culture may appear entirely normal and even desirable in others. For instance, epileptic seizures are treated by modern Western medicine as a sign of neurological malfunction. In certain shamanistic cultures, on the other hand, this has often been taken as a sign of divine favour or the ability to communicate with spirits. (Lewis 2003)  Therefore, it is not possible to speak of a monolithic and universal idea of health and wellness. For the purposes of this paper, we shall restrict ourselves to the modern Western conception of disease, with full cognizance of the fact that it only applies to certain cultures and historical periods.

Even within this limited sphere, there exists a range of social factors that impact an individual’s health status. These include gender, race, class, sexual identity, religion, ethnicity, cultural beliefs, and social status. In most contemporary societies across the world, it is taken as a given that economically backward classes have poorer access to healthcare. Aspects of well-being, such as attitudes toward childbearing, contraception, and abortion, are often influenced by religious ideas and social norms. (Clements 2015) Societal attitudes towards the ‘proper’ place of women can determine whether or not a woman gets the medical attention she deserves. Patriarchal attitudes have long been responsible for obfuscating the importance of gynaecological well-being as a worthy goal of research. In fact, Western society, until quite recently, tended to attribute any and all feminine complaints to ‘problems of the womb’ or ‘hysteria.’ (Lorber and Moore 2002)

Thus, there is no denying that social factors play a crucial role in determining an individual’s health status. Several scholars have made it their aim to study these patterns and have even developed models and theories to explain these phenomena. Of these, one of the more widely adopted is the rainbow model proposed by Dahlgren and Whitehead in 1991. It is worth considering this model as a springboard for the discussion ahead which will include relevant examples from time to time.


The Dahlgren-Whitehead model considers different types of determinants that influence one’s risk of falling ill, ability to prevent illness, and access to healthcare. (Dahlgren and Whitehead 1991) This model maps the individual’s relationship to various ‘inherent’ and ‘modifiable’ variables pertaining to genetics, environment, and lifestyle by organising these factors in concentric layers of declining influence the further away that they move from the center.

At its center are those factors intrinsic to the biological constitution that one has no control over. These biological ‘givens’ include age, sex, and heredity (including ethnicity). The next concentric layer is composed of individual lifestyle factors and behaviours that influence one’s risk of developing a disease. Arguably, an individual exercises a significant degree of control over these factors which include diet, activity level, habits, etc. Moving outwards, the next two layers are, respectively, ‘social and community networks’ (relationships with family, friends, other networks, etc) followed by ‘living and working conditions’ (housing, employment, sanitation, occupational hazards, etc.). The outermost layer is labelled ‘general socioeconomic, cultural and environmental factors’ (income, finances, clothing, travel, etc).

One of the strengths of this model is that it accounts for the ways in which social and other ‘outer’ factors can actually interact with and modify what are thought to be ‘givens.’ For example, inadequate maternal nutrition during pregnancy may result in preterm birth or low birth weight which can lead to a variety of health problems for the child. What may be taken as a given for the child as a result of the failure to achieve good nutrition during pregnancy is often linked to a variety of socioeconomic factors such as lack of awareness/education or lack of availability. In fact, even the choice of a reproductive partner is often governed by sociocultural norms and considerations, thus influencing the mix of genes passed on to future generations.

Others have gone on to refine this model or throw more light on social aspects and their causal relevance to health status. For instance, research has revealed that those who are able to achieve better social integration also have a reduced risk of mortality and morbidity. However, one of the critiques of this approach is that social factors are seen as yet another risk factor to add to the set of known risk factors. Through the example of maternal nutrition, we have seen how this model allows for an understanding of the interaction between multiple factors. Yet, critics point out that each factor is seen in a compartmentalised way without adequately theorizing the way in which the social acts as a matrix within which other factors may operate and interact.

Another critique attacks closer to the foundations of the model. The fundamental premise of this model is that disease is biological in nature and this, some claim, is a faulty assumption. (Paterson 1981) Alternative systems of medicine have long stressed the importance of good mental health and healthy thinking in maintaining good overall health. Scientific research is now starting to prove and substantiate these ideas. The etiology of the disease appears to be far more complex than previously thought. Thus, it has been argued that the predominantly biological conception of health is inherently lacking and, as a result, models attempting to describe its relationship with social factors are also incomplete.


Another important point that the theory mentioned above does not pay attention to is the question of how exactly illness is defined. At what point is a person deemed ill and in need of treatment or medical intervention? Surely, this is the very foundation upon which one must base any study attending to the causal factors related to health?

Conflict theory is, at its core, concerned with the question of inequalities between social groups; in particular how social, political, and economic institutions play a role in creating these disparities. (Turner 1975) Taking a conflict approach to the question of inequalities in health status brings up some startling new perspectives that end up entirely reframing the debate. One of the salient arguments made here is that the vested interests of the medical profession are partly responsible for the ‘medicalization’ of social problems. (Weitz 2003) The best way to explain this is through an example.

One of the best examples is that of eating disorders. Today, statistics show that eating disorders like anorexia nervosa have reached almost epidemic proportions. While it is possible that equivalent eating disorders existed in past centuries, but went unrecognised for what they were, what accounts for their sudden explosion? One possible cause is that now that it is recognised, it is the mere fact of accurate diagnosis that makes eating disorders seem more common. However, psychologists concur that one of the leading causes of eating disorders is distorted body image and that this is increasingly being encouraged by unrealistic standards of beauty propagated by the visual arts and other media. (Thompson and Heinberg 1999) In fact, the reach of media is now so universal and widespread that no one can escape it. These unrealistic standards of beauty have become culturally entrenched to an unprecedented extent. While the resultant effect on the mental and emotional health of women and men (women more than men) may manifest in the form of disturbed eating habits and nutritional deficiencies, the underlying problem is certainly a social one. However, the theory goes that the act of defining eating disorders as a medical problem allows the medical profession to monopolise (and, arguably, monetise) the treatment of it. Eliminating eating disorders requires a more broad-based attitudinal shift in society and cannot be likened to treating an infectious disease through public health programmes and vaccines. The two are not comparable at all.

Similarly, for generations, childbirth was facilitated by midwives or other experienced individuals. The discipline of obstetric medicine and the practice of hospitalisation for childbirth did not exist. Today, however, a major industry revolves around it and the prevalent belief is that women cannot and should not give birth in homes without the supervision of certified medical professionals. (Reiger 2008) Expensive tests, multiple check-ups, hospitalisation, imaging tests, expensive baby formula and the like create an enormous economic burden when the fact is that other ways do exist and have done for centuries. It suits doctors and the pharmaceutical industry to project the impression that childbirth cannot take place in any other way. At present, there is little incentive or social regard for midwifery with the result that women who cannot afford obstetric care in hospitals are all the more vulnerable.

This theory has been criticised as cynical and one-sided. Certainly, it is limited in its scope. This explanation is not applicable to all instances of disparity in health status and should not be seen as such. However, it does raise some pertinent points and it behoves the medical profession to introspect on these points. The argument has also been raised that the motivations of doctors in such instances are often benign and well-intentioned. For instance, ever since the advent of germ theory, it has become clear that one of the best ways to prevent illness and complications is to carry out any medical interventions in a sterile setting. In fact, the advent of modern obstetric care has significantly brought down the risk of pregnancy complications as well as mortality and morbidity resulting from pregnancy. Hence, the discipline of obstetric medicine has earned its rightful place. However, the commercialisation of perinatal care is certainly a social problem.


Assessment of health status and access to healthcare is contingent upon a variety of cultural, economic, and social factors. Individuals, communities, and governments in different parts of the world understand and prioritise health and healthcare differently. Ideas relating to health have also undergone monumental transformations with the advent of modern Western medicine and epidemiological theory. Often, social factors such as gender, age, social status, and class complicate this area even further.

Here, we have looked at two theories/models that attempt to explain some of these phenomena. The Dahlgren-Whitehead model aims to map the ways in which social aspects interact with other factors in determining health. It has broad application. On the other hand, the latter theory has its roots in a very specific Marxist line of thinking and looks at a more limited context (i.e. the role of the medical profession in converting social problems into medical ones). But, arguably, the conflict approach raises a more fundamental question as to how, really, we should be defining health and wellness in the first place.


Lewis, I.M., 2003. Ecstatic religion: a study of shamanism and spirit possession. Psychology Press.

Clements, B., 2015. Religion and Abortion. In Religion and Public Opinion in Britain (pp. 127-163). Palgrave Macmillan UK.

Lorber, J. and Moore, L.J., 2002. Gender and the social construction of illness. Rowman Altamira.

Dahlgren, G. and Whitehead, M., 1991. Policies and strategies to promote social equity in health. Stockholm: Institute for future studies.

Paterson, K., 1981. Theoretical perspectives in epidemiology – a critical appraisal. Radical Community Medicine (pp. 23–24).

Turner, J.H., 1975. Marx and Simmel revisited: Reassessing the foundations of conflict theory. Social Forces, pp.618-627.

Weitz, R., 2003. The sociology of health, illness, and health care: A critical approach. Recording for the Blind & Dyslexic.

Thompson, J.K. and Heinberg, L.J., 1999. The media’s influence on body image disturbance and eating disorders: We’ve reviled them, now can we rehabilitate them? Journal of social issues55(2), pp.339-353.

Reiger, K., 2008. Domination or mutual recognition? Professional subjectivity in midwifery and obstetrics. Social Theory & Health6(2), pp.132-147.

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