Social medicine

The field of social medicine seeks to implement social care through

  1. understanding how social and economic conditions impact health, disease and the practice of medicine and
  2. fostering conditions in which this understanding can lead to a healthier society.
A group of Chilean 'Damas de Rojo', volunteers on their local hospital and an example of social medicine

Social medicine as a scientific field gradually began 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. The field of social medicine is most commonly addressed today by public health efforts to understand what are known as social determinants of health.[1]

Scope

The major emphasis on biomedical science in medical education,[2] health care, and medical research has resulted into a gap with our understanding and acknowledgement of far more important social determinants of public health and individual disease: social-economic inequalities, war, illiteracy, detrimental life-styles (smoking, obesity), discrimination because of race, gender and religion. Farmer et al. (2006) gave the following explanation for this gap:[3]

The holy grail of modern medicine remains the search for a molecular basis of disease. While the practical yield of such circumscribed inquiry has been enormous, exclusive focus on molecular-level phenomena has contributed to the increasing "desocialization" of scientific inquiry: a tendency to ask only biological questions about what are in fact biosocial phenomena.

They further concluded that "Biosocial understandings of medical phenomena are urgently needed".[3]

Social care

Social care traditionally takes a different look at issues of impairment and disability by adopting a holistic perspective on health. The social model was developed as a direct response to the medical model, the social model sees barriers (physical, attitudinal and behavioural) not just as a biomedical issue, but as caused in part by the society we live in – as a product of the physical, organizational and social worlds that lead to discrimination (Oliver 1996; French 1993; Oliver and Barnes 1993). Social care advocates equality of opportunities for vulnerable sections of society.[4]

History

German physician Rudolf Virchow (1821–1902) laid foundations for this model. Other prominent figures in the history of social medicine, beginning from the 20th century, include Salvador Allende, Henry E. Sigerist, Thomas McKeown,[5] Victor W. Sidel,[6] Howard Waitzkin, and more recently Paul Farmer[7] and Jim Yong Kim.

In The Second Sickness, Waitzkin traces the history of social medicine from Engels, through Virchow and Allende.[8] Waitzkin has sought to educate North Americans about the contributions of Latin American Social Medicine.[9][10]

In 1976, the British public health scientist and health care critic Thomas McKeown, MD, published "The role of medicine: Dream, mirage or nemesis?", wherein he summarized facts and arguments that supported what became known as McKeown's thesis, i.e. that the growth of population can be attributed to a decline in mortality from infectious diseases, primarily thanks to better nutrition, later also to better hygiene, and only marginally and late to medical interventions such as antibiotics and vaccines.[11] McKeown was heavily criticized for his controversial ideas, but is nowadays remembered as "the founder of social medicine".[12]

See also

References
  1. Trout L, Kramer C, Fischer L (Dec 2018). "Social Medicine in Practice". 20 (2). Health and Human Rights Journal. PMC 6293359. PMID 30568399. Cite journal requires |journal= (help)
  2. Hixon, Allen L.; Yamada, Seiji; Farmer, Paul E.; Maskarinec, Gregory G. (2013-01-16). "Social justice: The heart of medical education". Social Medicine. 7 (3): 161–168. ISSN 1557-7112.
  3. Farmer, Paul, Bruce Nizeye, Sarah Stulac, and Salmaan Keshavjee (2006). "Structural violence and clinical medicine". PLOS Medicine. v.3(10): e449 (10): e449. doi:10.1371/journal.pmed.0030449. PMC 1621099. PMID 17076568.CS1 maint: multiple names: authors list (link)
  4. Kieran Walshe; Judith Smith (1 September 2011). Healthcare Management. McGraw-Hill Education (UK). pp. 261+. ISBN 978-0-335-24382-2.
  5. McKeown, Thomas and Lowe, C. R. (1966). An Introduction to Social Medicine. Oxford and Edinburgh: Blackwell Scientific Publications.CS1 maint: multiple names: authors list (link)
  6. Anderson, Matthew; Smith, Clyde Lanford (Lanny) (2013-11-03). "Honoring Vic Sidel". Social Medicine. 7 (3): 117–119. ISSN 1557-7112.
  7. Farmer, Paul (2002). Social medicine and the challenge of biosocial research. In: Opolka U, Schoop H (editors): Innovative Structures in Basic Research: Ringberg-Symposium, 4–7 October 2000. München: Max-Planck-Gesellschaft. pp. 55–73.
  8. Howard., Waitzkin (2000). The second sickness : contradictions of capitalist health care (Rev. and updated ed.). Lanham, Md.: Rowman & Littlefield. ISBN 9780847698875. OCLC 42295890.
  9. Waitzkin, Howard; Iriart, Celia; Estrada, Alfredo; Lamadrid, Silvia (2001-10-01). "Social Medicine Then and Now: Lessons From Latin America". American Journal of Public Health. 91 (10): 1592–1601. doi:10.2105/AJPH.91.10.1592. ISSN 0090-0036. PMC 1446835. PMID 11574316.
  10. Waitzkin, Howard; Iriart, Celia; Estrada, Alfredo; Lamadrid, Silvia (2001-07-28). "Social medicine in Latin America: productivity and dangers facing the major national groups". The Lancet. 358 (9278): 315–323. doi:10.1016/s0140-6736(01)05488-5. ISSN 0140-6736. PMID 11498235. S2CID 38877645.
  11. McKeown, Thomas (1976). The Role of Medicine: Dream, Mirage or Nemesis? (The Rock Carlington Fellow, 1976). London, UK: Nuffield Provincial Hospital Trust. ISBN 978-0-900574-24-5.
  12. Deaton, Angus (2013). The Great Escape. Health, wealth, and the origins of inequality. Princeton and Oxford: Princeton University Press. pp. 91–93. ISBN 978-0-691-15354-4. McKeown's views, updated to modern circumstances, are still important today in debates between those who think that health is primarily determined by medical discoveries and medical treatment and those who look to the background social conditions of life.
Bibliography
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