Academic journal article Health and Social Work

Health Inequities: Evaluation of Two Paradigms

Academic journal article Health and Social Work

Health Inequities: Evaluation of Two Paradigms

Article excerpt

As a social worker in various Canadian health settings, I began to question how to best address the health inequities that I was encountering in practice. This led to an academic exploration of how different health paradigms--biomedical, public health, biopsychosocial, social determinants of health, political economy, and holism--shape theory and practice in health. At the conclusion of my research, it was apparent that the two paradigms that most focus on health inequities were the social determinants of health and political economy paradigms. This article engages in a review of the implications each of these two paradigms' underlying epistemologies and subsequent definitions of health. Although the social determinants of health and political economy paradigms are relevant for all social scientists, the present discussion emphasizes their implications for social work practice and discourse.

My use of the term paradigm in this article has been informed by two definitions provided by Kuhn (1996). First, he describes how the concept of paradigm refers to the collection of beliefs, values, and approaches held by members within a particular community. Second, he uses the term to describe particular elements in that constellation of beliefs, including the concrete solutions that are used by members of a community. In this sense, "paradigm" refers to all those things shared among members of a specific community.

Just as any paradigm analysis encourages an examination of the basic beliefs and assumptions that define and organize the nature of the world, a more specific consideration of health paradigms allows for the identification and deconstruction of the larger forces that shape approaches to health (Guba & Lincoln, 2005; Nelson, Lord, & Ochocka, 2001). All theory making and methods of research that guide practice are built on paradigms (Payne, 2005). The term "paradigm" has been criticized for being vague (Bates, 2006); nevertheless, looking at health through the lens of its defining paradigms has the benefit of providing a framework for understanding the historical and social influences that have shaped thinking in a particular realm.


Payne's (2005, 2006b) typology of social work is a useful tool to help demonstrate how individual health paradigms conceive of health inequities and affect social work practice. Payne has described three fundamental views of social work; each of these views delineates a particular way in which the interplay between paradigm, theory, and practice manifests. All three views may be visible in any given social work practice to varying degrees: "Every bit of practice, all practice ideas, all social work agency organization and all welfare policy is a rubbing up of [these] three views of social work against each other" (Payne, 2006b, p. 12).

Therapeutic View (Reflexive-Therapeutic)

The therapeutic view is foundational to social work practice and discourse. It conceives of social work as striving for the optimal well-being of individuals, groups, and communities by encouraging and facilitating growth and self-fulfillment (Payne, 2006b). It focuses on the interface between social workers and their clients when the goal of the former is to achieve the well-being and growth of the latter. Through this interaction, clients gain power over both their internalized processes and the external world in which they live.

Social Order View (Individualist-Reformist)

The social order view sees social work as a component of welfare services (Payne, 2006b). The intent of social work, according to this view, is to assist people during periods of difficulty until a state of stability has been achieved.

Transformational View (Socialist-Collectivist)

The transformational view of social work asserts that societies must first be transformed for those who are oppressed to benefit in any meaningful way. …

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