Genesis and evolution of social medicine

Genesis and evolution of social medicine:

Preventive and Social Medicine (PSM) is relatively a new branch of medicine. It is often considered synonymous with Community Medicine, Public Health, and Community Health in India. All these share common ground, i.e. prevention of disease and promotion of health. In short, PSM provides comprehensive health services ranging from preventive, promotive, curative to rehabilitative services. The importance of the specialty of PSM has been very well recognized and emphasized repeatedly from grass root to international levels, not only in health sector but in other related sectors too. Whereas clinical specialties look after individual patient, PSM has to think and act in terms of whole community. The scope of medicine has expanded during the last few decades to include not only health problems of individuals, but those of communities as well. If we want to achieve Health for All, Community Medicine will definitely be the key factor during the next millennium.

The following points elaborate the evolution of social medicine:

The industrial revolution of the 18th century while bringing affluence also brought new problems ‐ slums, accumulation of refuse and human excreta, overcrowding and a variety of social problems. Frequent outbreaks of cholera added to the woes Chadwick’s report on ‘The Sanitary Conditions of Laboring Population (1842)’ focused the attention of the people and Government on the urgent need to improve public health. Filth and garbage were recognized as

man’s greatest enemies and it lead to great sanitary awakening bringing Public Health Act of 1848 in England, in acceptance of the principle that the state is responsible for the health of the people. The act was made more comprehensive in 1875 when Public Health Act 1875 was enacted. The public health movement in USA followed closely the English pattern. The organized professional body, American Public Health Association was formed in 1872. The Indian Public Health Association was formed in 1958.

Public Health is defined as the process of mobilizing local, state, national and international resources to solve the major health problems affecting communities and to achieve Health For All by 2000 AD.

Many different disciplines contributed to the growth of Public Health; physicians diagnosed diseases; sanitary engineers built water and sewerage systems; epidemiologists traced the sources of disease outbreaks and their modes of transmission; vital statisticians provided quantitative measures of births and deaths; lawyers wrote sanitary codes and regulations; public health nurses provided care and advice to the sick in their home; sanitary inspectors visited factories and markets to enforce compliance with public health ordinances; and administrators tried to organize everyone within the limits of the health departments budgets. Public Health thus involved Economics, Sociology, Psychology, Law, Statistics, and Engineering as well as biological and clinical sciences. Soon another important and emerging branch of medicine i.e., Microbiology became an integral part of Public Health. Public Health during the 19th Century was around sanitary regulations and the same underwent changes

Preventive Medicine developed as a branch of medicine distinct from Public Health. By definition, preventive medicine is applied to ‘healthy’ people, customarily by actions affecting large numbers or populations. Its primary objective is prevention of disease and promotion of health. It got a firm foundation only after the discovery of causative agents of diseases and the establishment of the germ theory of disease. The development of laboratory methods for the early detection of disease was a further advance.

Social Medicine has varying meanings attached to it. By derivation, it is the study of man as a social being in his total environment. It may be identified with care of patients, prevention of disease, administration of medical services; indeed with almost any subject in the extensive field of health and welfare. In short, social medicine is not a new branch of medicine but rather a new orientation of medicine to the changing needs of man and society.

Community Medicine has been defined as that specialty which deals with populations…. and comprises those doctors who try to measure the needs of the population, both sick and well, who plan and administer services to meet those needs, and those who are engaged in research and teaching in the field.

Decades old concept of health care approach has experienced a dramatic change. Today health is not merely an absence of disease; it is related to quality of life instead. Health is considered a means of productivity. Thus health development is essential to socio‐economic development as a whole. Since health is an integral part of development, all sectors of society have an effect on health. Scope of medicine has extended from individual to community. Study of health and disease in population is replacing study of disease in man. Germ theory of disease gave place to

newer concepts ‐ multi‐factorial causation. Social and behavioral aspects of the disease have been accorded a new priority. Contemporary medicine is no longer solely an art and science for the diagnosis and treatment of diseases. It is also the science for the prevention of disease and promotion of health. Today technical sophistication of modern medicine is not an answer to everyday common ailments of the vast poor in the country. Appropriate technology and cheaper interventions like Oral Rehydration Solution (ORS), immunization, etc are increasingly being applied as life saving measures and for disease prevention in community health care. Physicians’ role is no longer confined to diagnosing and treating those who come to the clinic. He is also responsible for those who need his service but cannot come to the clinic. Health of the people is not only the concern of health care providers. It is the responsibility of the community also to identify and solve their own health problems through their active participation.

All these changes in concept and ideas of health and health care system are embodied in community health care. The spate of new ideas and concepts, for example, increasing importance given to social justice and equity, recognition of crucial role of community participation called for the new approaches to make medicine in the service of humanity more effective.

Alma‐Ata declaration in 1978 specified that Primary Health Care approach was the way of achieving the goal of Health For All by 2000 AD. Primary Health Care approach stressed that “essential health care should be made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and the country can afford”.