BIOPSYCHOSOCIAL

CONTEXT OF
CHRONIC NCDs
Maged El-Setouhy MD
Professor at the Department of Family and Community Medicine
Faculty of Medicine. Jazan University
ma.elsetouhy@gmail.com
0568069515
 LEARNING OBJECTIVES
• Understand models of chronic illness and disability.

• Understand psychosocial, environmental, and attitudinal

aspects of chronic illness and disability.

• Understand the culture within the context of chronic illness

and disability.

• Understand adjustment to chronic illness and disability

models for individuals and families.
 Noncommunicable Diseases
• Noncommunicable diseases (NCDs)
are the leading cause of death
globally, and one of the major health
challenges of the 21st century.
Models of Chronic
Illness and
Disability
 Medical Model
(functional model)
• The medical model conceptualizes chronic illness
and disability as phenomena that stem solely
from a disease or disorder and require medical
intervention to fix and/or cure the condition.

• Medical professionals perform disability

determinations based on their clinical
impression of the severity of the condition and
its impact on the person’s ability to learn,
communicate, work, and perform daily activities
(e.g., bathing, dressing, cooking).
 Social Model
• The social model views disability as a social
construct, positing that health conditions are not
inherently disabling but that societal exclusion and
inaccessible environments
• The social model considers body impairments as
components of cultural diversity versus a
biological deficiency.
• The social model is grounded in the disability
rights movement; thus, self-advocacy is a critical
component of the social model of disability.
• Self-advocacy is based on persons with disabilities
engaging in social and political collective action to
shape their social role and legal treatment
COMPARISON BETWEEN MEDICAL
AND SOCIAL MODELS OF
DISABILITY DISCOURSE
Topic Medical Model
Definition of disability An individual or medical
phenomenon that results
from impairments in body
functions or structures; a
deficiency or abnormality
Access to treatment or Referral by diagnosis
services
Targets of interventions “Fixing” the disability to the
greatest extent possible;
“normalizing”
Outcome of interventions Normalized function;
functioning member of
existing society
Perception of disability Being disabled is negative
Social Model
A social construct that is
imposed on top of
impairments by society; a
difference
Self-referral, experience-
driven
Social or political change in
an effort to decrease
environmental barriers and
increase the levels of
understanding
Self-advocacy, changes in
environment and
understanding, social
inclusion
Being disabled, in itself, is
neither positive nor negative
Topic
The agent of remedy
Effects on individuals who
are typically functioning
Perceptions toward
individuals with disabilities
Cognitive authority
Perception of disability
Medical Model Social Model
The professional Potentially, the individual,
an advocate, or anyone who
positively affects the
arrangements between the
individual and society
Society remains the same Society evolves to be more
inclusive
The individual is faulty The individual is unique
Scientists and physician Academics and advocates
with disabilities
Being disabled is negative Being disabled, in itself, is
neither positive nor negative
 George L. Engel
(1913-1999)

• Believed that to better understand and help

patients, clinicians must attend
simultaneously to the biological, psychological
and social dimensions of illness.
• Believed in the importance of biomedical
model, but still criticized it for being too
narrowed and focusing on patients as objects.
• He is known for BIOPSYCHOSOCIAL MODEL.
 Biopsychosocial Model
• The biopsychosocial model is a general
model or approach stating that:
– Biological (genes, nutrition, hormones,
toxins etc.),
– Psychological (thoughts, emotions &
behaviors),
– Social (socio-economical, socio-
environmental, and cultural)
 Biopsychosocial Model
• The biopsychosocial model posits that health
and disability reflect a complex interaction of
biological, psychological, and social factors
(Falvo & Holland, 2017)

• It implies that many factors, not simply the

health condition itself, determine the
functional impact of a health condition and
level of disability.
 Interaction between components of
International Classification of Functioning,
Disability and Health (ICF).

WHO 2001:18
 Activity
• Activity refers to tasks or actions that
individuals carry out in daily life, such as
dressing, bathing, cooking, eating, cleaning,
dressing, paying bills, and managing other
daily tasks/routines.

• Disability may occur at this level when activity

limitations occur that prevent the individual
from optimally performing their daily
activities.
 Activity
• Reducing the level of disability associated with
activity limitations may involve environmental
resources (e.g., insulin pump, family support) and
personal resources (e.g., symptom management,
coping style, income).

• Participation refers to an individual’s involvement

in activities in the broader social system, such as
going to school, holding a job, engaging in
recreational activities, or being integrated into the
community
 Person–Environment or
contextual factors
• They consist of two components, namely,
environmental factors and personal factors.
• Both components include factors that can be either
facilitators or barriers to optimal functioning and
disability.
• Environmental factors may include factors such as
rehabilitation counseling, physical accessibility, home
modifications, work/school accommodations,
transportation, technology, SSDI, service animal,
wheelchair, medications, climate, and sociopolitical,
legal, and cultural factors (e.g., the Americans with
Disabilities Act [ADA], the ACA, the IDEA, Individual
Education Plans, healthcare policy, systems of
oppression, ableism, racism, microaggressions).
 ICF
• The International Classification of Functioning,
Disability and Health (ICF) is a framework for
describing and organizing information on
functioning and disability.
DEFINITIONS OF ICF COMPONENTS
 BIOPSYCHOSOCIAL MODEL
• These factors, all play a significant role in
human functioning in the context
of disease or illness.
• The biopsychosocial approach systematically
considers biological, psychological, and social
factors and their complex interactions in
understanding health, illness, and health care
delivery.
BIOPSYCHOSOCIAL MODEL
 Biopsychosocial Model
• Humanistic qualities are highly valued
complements to the biopsychosocial approach,
which involves the application of the scientific
method to diverse biological, psychological, and
social phenomena as related to human health.
• The medical model is reductionistic in that it
views disease as nothing more than deviation
from the norm of “measurable biological
variables.”
 Biopsychosocial Model
• The problem of psychiatry fitting with the
medical model.
• The medical model as “a model of disease no
longer adequate for the scientific tasks and
social responsibilities of either medicine or
psychiatry,” and listed what he believed to be
the shortcomings of the medical model.
 Biopsychosocial Model
• While the biomedical approach takes the
reductionistic view that all phenomena are
best understood at the lowest level of natural
systems (e.g., cellular or molecular), the
biopsychosocial approach recognizes that
different clinical scenarios may be most
usefully understood scientifically at several
levels of the natural systems continuum.
Biopsychosocial Model
 Biopsychosocial Model
To apply the biopsychosocial approach to clinical
practice, the clinician should:
• Recognize that relationships are central to
providing health care
• Use self-awareness as a diagnostic and
therapeutic tool
• Elicit the patient’s history in the context of life
circumstances
 Biopsychosocial Model
• Decide which aspects of biological,
psychological, and social domains are most
important to understanding and promoting the
patient’s health
• Provide multidimensional treatment
 Biopsychosocial Model
• Prejudice.

• Microaggressions.

• Stigma.