Searching for the social model of health in policy: health in all policies, or wellbeing?

Abstract International policy efforts to systematise the consideration of health outcomes across social and economic policy – the ‘Health in All Policies’ (HiAP) approach – have faced practical, relational and political difficulties. Meanwhile, new economic policy agendas focused on ‘inclusive growth’ or ‘wellbeing’ may provide an alternative route to improving population health by acting on upstream determinants. This research uses a frame analysis of thirty social, economic and health policy documents, and semi-structured interviews with thirty-four policy actors, to explore conceptualisations of ‘health’ in two devolved policy bodies in the UK – Greater Manchester Combined Authority and the Scottish Government – with declared interests in these economic agendas. Interviews revealed that social and economic policy actors conceptualised ‘health’ narrowly as biomedical, physical illness, and as shorthand for ‘health policy’. Further, some of these participants expressed resentment about health policy, while interviewees across teams expressed scepticism about HiAP. In contrast, ‘wellbeing’ was widely conceptualised similarly to the social model of health, included mental health, and was supported as a plausible common cause. This research suggests that a clearer conceptual distinction between ‘healthcare’ and ‘wellbeing’ – representing the medical and social models of health respectively – may support policy efforts to promote population health.