Social medicine

A group of Chilean 'Damas de Rojo', volunteers on their local hospital and a clear example of social medicine.

The field of social medicine seeks to:

  1. understand how social and economic conditions impact health, disease and the practice of medicine and
  2. 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, Thomas McKeown [1], Victor Sidel,[2] Howard Waitzkin, and more recently Paul Farmer[3] and Jim Yong Kim.

In The Second Sickness, Howard Waitzkin traces the history of social medicine from Engels, through Virchow, through Allende.[4] Waitzkin has sought to educate North Americans about the contributions of Latin American Social Medicine.[5][6]

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 the 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.[7] McKeown was heavily criticized for his controversial ideas, but is nowadays remembered as 'the founder of social medicine'.[8]

The major emphasis on biomedical science in medical education,[9] 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:[10]

'One reason for this gap is that 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'.[10]

The field of social medicine is most commonly addressed today by public health efforts to understand what are known as social determinants of health.

See also

References

  1. ↑ McKeown, Thomas and Lowe, C.R. (1966). An Introduction to Social Medicine. Oxford and Edinburgh: Blackwell Scientific Publications.
  2. ↑ Anderson, Matthew; Smith, Clyde Lanford (Lanny) (2013-11-03). "Honoring Vic Sidel". Social Medicine. 7 (3): 117–119. ISSN 1557-7112.
  3. ↑ 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.
  4. ↑ Howard., Waitzkin, (2000). The second sickness : contradictions of capitalist health care (Rev. and updated ed ed.). Lanham, Md.: Rowman & Littlefield. ISBN 9780847698875. OCLC 42295890.
  5. ↑ 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. ISSN 0090-0036. doi:10.2105/AJPH.91.10.1592.
  6. ↑ 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. ISSN 0140-6736. doi:10.1016/s0140-6736(01)05488-5.
  7. ↑ McKeown, Thomas (1976). The Role of Medicine: Dream, Mirage or Nemesis? (The Rock Carlington Fellow, 1976). London, UK: Nuffield Provincial Hospital Trust. ISBN 0-900574-24-0.
  8. ↑ 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.
  9. ↑ 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.
  10. 1 2 Farmer, Paul, Bruce Nizeye, Sarah Stulac, and Salmaan Keshavjee (2006). "Structural violence and clinical medicine". PLoS Medicine. v.3(10): e449. PMC 1621099 Freely accessible.
Bibliography
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