Social medicine

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Social medicine is an interdisciplinary field that focuses on the interplay between socio-economic factors and individual health outcomes. Rooted in the challenges of the Industrial Revolution, it seeks to:

Contents

  1. Understand how specific social, economic, and environmental conditions directly impact health, disease, and the delivery of medical care.
  2. Promote conditions and interventions that address these determinants, aiming for a healthier and more equitable society.

Social medicine as a scientific field gradually began in the early 19th century in Europe, during 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 efforts to understand what are known as social determinants of health. [1]

Scope

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

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 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 aims to promote wellness and emphasizes preventive, ameliorative, and maintenance efforts during illness, impairment, or disability. It adopts a holistic perspective on health and encompasses a variety of practices and viewpoints aimed at disease prevention and reduction of the economic, social, and psychological burdens associated with prolonged illnesses and diseases. [4] 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. [5]

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, [6] Victor W. Sidel, [7] Howard Waitzkin, and more recently Paul Farmer [8] and Jim Yong Kim.

In The Second Sickness, Waitzkin traces the history of social medicine from Engels, through Virchow and Allende. [9] Waitzkin has sought to educate North Americans about the contributions of Latin American Social Medicine. [10] [11]

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. [12] McKeown was heavily criticized for his controversial ideas, but is nowadays remembered as "the founder of social medicine". [13]

Occupational health and social medicine

The world of work played a fundamental role in the development of a social approach to health during the first industrial revolution, as exemplified by Virchow’s work on typhus and coal miners. [14] Over the past 50 years, Occupational Safety and Health. [15]  The resulting distinction between work/nonwork related risks and outcomes has served as an artificial line of demarcation between OSH and the rest of public health. [16] However, growing social inequality, the fundamental reorganization of the world of work, [17]   and a broadening of our understanding of the relationship between work and health [18] have blurred this line of demarcation and highlight the need to expand and complement the reductionist view of cause and effect.  In response, OSH is reintegrating a social approach to account for the social, political, and economic interactions that contribute to occupational health outcomes. [19]  

See also

References

  1. ↑ Trout L, Kramer C, Fischer L (Dec 2018). "Social Medicine in Practice". Health and Human Rights. 20 (2): 19–30. PMC   6293359 . PMID   30568399.
  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. doi: 10.71164/socialmedicine.v7i3.2013.671 . ISSN   1557-7112.
  3. 1 2 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ↑ Lowy, Louis (1979). Social Work with the Aging: The Challenge and Promise of the Later Years. New York: Harper & Row. ISBN   978-0-06-044085-5.
  5. ↑ Kieran Walshe; Judith Smith (1 September 2011). Healthcare Management. McGraw-Hill Education (UK). pp. 261+. ISBN   978-0-335-24382-2.
  6. ↑ McKeown, Thomas and Lowe, C. R. (1966). An Introduction to Social Medicine. Oxford and Edinburgh: Blackwell Scientific Publications.{{cite book}}: CS1 maint: multiple names: authors list (link)
  7. ↑ Anderson, Matthew; Smith, Clyde Lanford (Lanny) (2013-11-03). "Honoring Vic Sidel". Social Medicine. 7 (3): 117–119. doi: 10.71164/socialmedicine.v7i3.2013.669 . ISSN   1557-7112.
  8. ↑ 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.
  9. ↑ Howard., Waitzkin (2000). The second sickness : contradictions of capitalist health care (Rev. and updated ed.). Lanham, Md.: Rowman & Littlefield. ISBN   9780847698875. OCLC   42295890.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ "NIOSH eNews - Volume 18, Number 10 (February 2021)". Centers for Disease Control and Prevention. 2022-05-13. Retrieved 2023-06-13.
  15. ↑ Albert, Farre (December 2017). "The New Old (and Old New) Medical Model: Four Decades Navigating the Biomedical and Psychosocial Understandings of Health and Illness". Healthcare. 5 (4): 88. doi: 10.3390/healthcare5040088 . PMC   5746722 . PMID   29156540.
  16. ↑ Peckham, T. K.; Baker, M. G.; Camp, J. E.; Kaufman, J. D.; Seixas, N. S. (2017). "Creating a Future for Occupational Health". The Annals of Occupational Hygiene. pp. 3–15. doi:10.1093/annweh/wxw011. PMID   28395315.{{cite web}}: Missing or empty |url= (help)
  17. ↑ Tamers, Sara (September 14, 2020). "Envisioning the future of work to safeguard the safety, health, and well-being of the workforce: A perspective from the CDC's National Institute for Occupational Safety and Health". American Journal of Industrial Medicine. 63 (12): 1065–1084. doi: 10.1002/ajim.23183 . PMC   7737298 . PMID   32926431.
  18. ↑ Ahonen, Emily (January 2018). "Work as an Inclusive Part of Population Health Inequities Research and Prevention". American Journal of Public Health. 108 (3): 306–311. doi:10.2105/AJPH.2017.304214. PMC   5803801 . PMID   29345994.
  19. ↑ Flynn, Micheal (2021). "Health Equity and a Paradigm Shift in Occupational Safety and Health". International Journal of Environmental Research and Public Health. 19 (1): 349. doi: 10.3390/ijerph19010349 . PMC   8744812 . PMID   35010608.

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