Bio-Psycho-Socio-Economic Model (BPSE)

Conceptual models, or ways of seeing the world, underlie most of human life and determine a lot of what we do.  For example, when Europeans thought the world was flat, sailors stayed close to land for fear of falling off the edge.  When they started thinking it was round, sailors found the courage to set off across the ocean and discovered North America.  There are conceptual models about many aspects of life.  Often we are unaware of them because we confuse the model with the reality it is attempting to describe.

The “bio-psycho-socio-economic” (or “BPSE” — pronounced "bipsee") model of sickness and disability — which the Praxis Partners Consortium recommends — integrates elements from several other conceptual models that have been the foundation for thought in different parts of society, particularly in healthcare delivery, insurance/benefit programs, employment, and government.  The lack of a widely-accepted and integrated model to explain why people get sick, how they respond to health challenges, and what to do about it explains the differences and inadequacies in the way the various sectors respond to their needs.  The contributing conceptual models are:

• The “bio-medical model” which has been the foundation for the healthcare delivery system in the US since the early 1900’s.

• The “economic model” which been the foundation of public and private benefit program designs (e.g., workers’ compensation as well as commercial and governmental disability programs) since their inception.

• The “social model” which has been espoused by disability rights advocates and undergirds many human services programs and human rights/employment rights legislation and regulations (e.g., the Americans with Disabilities Act, the EEOC).

None of the models above adequately takes into account the huge role played by our innate human nature in how we respond to life’s challenges: how our whole human being (mind/brain/nervous system/body) learns from past experience and how it influences the way we think and behave; how we see our situation, the world, and our options; what strategies we employ; and the choices we make.

The breakthrough that led to the BPSE model was the development of the “biopsychosocial” model originally conceptualized by an American psychiatrist named George Engel in 1977.  He used it to explain the power of context in determining health and illness, specifically the complex interplay of biological, psychological, and social factors in human life.  This model recognizes that all issues relating to health are products of a complex interaction of any number of factors in these three broad domains, and asserts that effective management of health problems often requires acknowledging the contribution being made by factors in all of them.

An excellent monograph describes the earlier bio-medical, economic, and social models of disability and contrasts them with the biopsychosocial model.  Written by two influential UK physicians, Gordon Waddell and Mansel Aylward, the monograph can be found at: www.webility.md/praxis/downloads/Models-of-Sickness-Disability-Waddell-and-Aylward-2010-2.pdf

The BPSE model recommended by Praxis Partners includes the suffix “economic” in order to explicitly acknowledge the important role played by financial realities and incentives, but also to assert the difference between social and economic factors.  Recent research has shown that human beings are powerfully influenced by innate human drives, cultural values, and personal history as well as each individual’s own worldview, priorities, philosophy of life, and expectations.  A simpler name for the BPSE model could be the “whole life” model.