What is Social Medicine? Meaning and scope:
This history dates back
(at least) to the early nineteenth century when the systematic study of the
relationships between society, disease, and medicine began in earnest. This
study—and the forms of medical practice derived from it—became known as “social
medicine.” Over time the term “social medicine” took on varied meanings as it
was adapted to differing societies and diverse social conditions. Nonetheless,
certain common principles underlie the term:
·
Social and
economic conditions profoundly impact health, disease, and the practice of
medicine.
·
The health of
the population is a matter of social concern.
·
Society should
promote health through both individual and social means.
Social conditions
contribute to ill health. This was described as early as the 19th century by
Rudolf Virchow, generally considered the founder of social medicine.
Social medicine, an
approach to the prevention and treatment of disease that is based on the study
of human heredity, environment, social structures, and cultural values.
It is the field of
medicine that studies the impact of the collective behavior of organized
society on individuals belonging to various, often disadvantaged, subgroups
within the society. This is found in Engel’s phenomenon of Homelessness,
Latchkey children, Supermom. Socialized medicine.
It is a specialized
field of medical knowledge concentrating on the social, cultural, and economic
impact of medical phenomena. The field of social medicine seeks to: understand
how social and economic conditions impact health, disease and the practice of
medicine and foster conditions in which this understanding can lead to a
healthier society.
This type of study
began formally in the early 19th century. The Industrial Revolution and the
subsequent increase in poverty and disease among workers raised concerns about
the effect of social processes on the health of the poor.
Prominent figures in
the history of social medicine include Rudolf Virchow, Salvador Allende, and
more recently Paul Farmer and Jim Yong Kim.
More specifically,
Farmer et al. (2006) state that "Biosocial understandings of medical
phenomena [such as the social determinants of health] are urgently
needed". Paul Farmer's view is that modern medicine is focused at the
molecular level, and there is a "gap" between social analysis and
everyday clinical practices
Moreover, Farmer,
Nizeye, Stulac and Keshavjee (2006) view social medicine with increasing
importance as scientific inquiry is increasingly "desocialized". The
latter refers to "...a tendency to ask only biological question about what
are in fact biosocial phenomena.
The field of social
medicine is most commonly addressed today by public health efforts to
understand what are known as social determinants of health.
Social medicine is
distinguished from medico biological and clinical disciplines that study
healthy and diseased states of the body.
Social medicine is
closely related to the social sciences, including political economy, sociology,
demography, and the general theory of administration. It concentrates primarily
on social conditions and studies the interrelationships between social and
biological factors in medicine. Evaluations are made primarily on the basis of
statistics.
Social medicine also
utilizes evaluations made by specialists in various fields, experiments,
models, questionnaires, and the historical method.
The bases of social
medicine are associated with the study of occupational diseases, medico
topographical data, and public‐health statistics. In
the late 18th century the use of J. P. Frank’s system of medical police
promoted the state regulation of public health. In the 19th century the
development of social medicine was associated with the rise of capitalism and
with bourgeois‐democratic revolutions. In Great Britain, France,
Germany, and other countries data were gathered on how working and living
conditions affected the health of workers. Statistical methods were used in
making evaluations, and attempts were made to substantiate scientifically
public‐health measures. The term “social medicine” was
introduced at this time.
From the late 18th
century until the 1870’s specific issues were presented in medical‐ police and social‐medicine
courses in various countries. At the turn of the 20th century chairs of social
medicine were established, and independent courses in social medicine and
social hygiene were given by A. V. Korchak‐Chepurkovskii
in Kiev (from 1906), A. I. Shingarev in St. Petersburg (from 1908), L. Teleky
in Vienna (from 1909), and A. Grotjahn in Berlin (from 1912). The subsequent
development of social medicine proceeded under the influence of social
democratic ideas and the class struggle of the proletariat in capitalist
countries.
The organizational
basis of social medicine is the Soviet system of public health, which is
directed toward the socioeconomic transformation of society and the elimination
of social roots generating diseases and which makes available state measures
for the protection of the health of citizens. It is under socialist conditions
that social medicine is best able to elaborate the scientific bases for
therapeutic preventive measures fostering the harmonious physical and spiritual
development of man and promoting maximum life expectancy. The development of
social medicine and the introduction of preventive medicine into medical
practice and into the system of medical education were promoted by the
activities of the sub departments of social medicine created in the First
Moscow State University (N. A. Semashko, 1922), the Second Moscow State
University (Z. P. Solov’ev, 1923), and the State Institute of Social Medicine
(A. V. Mol’kov, 1923). Sub departments of social medicine were later created in
all higher medical institutions.
The leading scientific
center on social medicine and public‐health
administration is the N. A. Semashko All‐Union
Scientific Research Institute of Social Medicine and the Organization of Public
Health of the Ministry of Public Health of the USSR (Moscow). Research is being
conducted in the USSR on theoretical issues of social medicine and the
organization of public health, on social conditions and the health of the
population, and on the scientific foundations of the economics and planning of
public health. An automated public‐health
planning and administration system is being developed, and the scientific
foundations of the organization of medical care and the training and education
of the population in social medicine are under study. Social medicine is part
of the curriculum at
several institutions outside the USSR, including the Institute of Social
Hygiene and Health Organization of the People’s Republic of Bulgaria, the
Academy for Advanced Training of Physicians in the German Democratic Republic,
and the Institute of Social Medicine and Organization of Public Health of the
Czechoslovak Socialist Republic. All‐Union,
republic, and local societies of hygienists and public‐health physicians have groups specializing in social
medicine. International organizations that function in the area of social
medicine include the World Health Organization (founded 1948), the
International Medical Association for the Study of Living Conditions and Health
(founded 1951), and the European Association of Social Medicine (founded 1955).
In the USSR, social
medicine is taught at medical institutes by departments of therapeutics,
pediatrics, and public health and hygiene under the control of sub departments
of social medicine and public‐health organizations
(from 1941 to 1966— sub‐departments of public‐health organizations). Outside the USSR it is
controlled by sub departments of social medicine, public‐health organizations, and community health
protection.
The most important
domain of social medicine is the culture itself. Health professionals and
institutions have their own cultures that also go beyond clinical interactions.
Health systems and health research both contain agendas, prejudices, and
beliefs that can lead to certain perspectives being favored as the most
legitimate. Understanding the culture of medicine is essential to understanding
health professionals' attitudes toward illness, patients, and treatments.
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