Social medicine

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

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.

Public health preventing disease, prolonging life and promoting health through organized efforts and informed choices of society and individuals

Public health has been defined as "the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the health of a population and the threats it faces is the basis for public health. The public can be as small as a handful of people or as large as a village or an entire city; in the case of a pandemic it may encompass several continents. The concept of health takes into account physical, psychological and social well-being. As such, according to the World Health Organization, it is not merely the absence of disease or infirmity.

The social determinants of health are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk for a disease, or vulnerability to disease or injury. The distributions of social determinants are often shaped by public policies that reflect prevailing political ideologies of the area. The World Health Organization says, "This unequal distribution of health-damaging experiences is not in any sense a 'natural' phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements [where the already well-off and healthy become even richer and the poor who are already more likely to be ill become even poorer], and bad politics."


The major emphasis on biomedical science in medical education, [1] 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: [2]

'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'. [2]

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. [3]


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, [4] Victor W. Sidel, [5] Howard Waitzkin, and more recently Paul Farmer [6] and Jim Yong Kim.

Rudolf Virchow German doctor, anthropologist, public health activist, pathologist, prehistorian, biologist and politician

Rudolf Ludwig Carl Virchow was a German physician, anthropologist, pathologist, prehistorian, biologist, writer, editor, and politician. He is known as "the father of modern pathology" and as the founder of social medicine and zoology, and to his colleagues, the "Pope of medicine". He received the Copley Medal in 1892. He was a foreign member of the Royal Swedish Academy of Sciences and was elected to the Prussian Academy of Sciences, but he declined to be ennobled as "von Virchow".

Salvador Allende Chilean physician and politician

Salvador Guillermo Allende Gossens was a Chilean democratic socialist politician and physician, President of Chile from 1970 until 1973, and head of the Popular Unity political coalition government; he was the first ever Marxist to be elected president in a country with liberal democracy.

Henry E. Sigerist Swiss medical historian

Henry Ernest Sigerist was a Swiss medical historian.

In The Second Sickness, Howard Waitzkin traces the history of social medicine from Engels, through Virchow, through Allende. [7] Waitzkin has sought to educate North Americans about the contributions of Latin American Social Medicine. [8] [9]

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. [10] McKeown was heavily criticized for his controversial ideas, but is nowadays remembered as 'the founder of social medicine'. [11]

See also

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Structural violence is a term commonly ascribed to Johan Galtung, which he introduced in the article "Violence, Peace, and Peace Research" (1969). It refers to a form of violence wherein some social structure or social institution may harm people by preventing them from meeting their basic needs. Institutionalized adultism, ageism, classism, elitism, ethnocentrism, nationalism, speciesism, racism, and sexism are some examples of structural violence as proposed by Galtung. According to Galtung, rather than conveying a physical image, structural violence is an "avoidable impairment of fundamental human needs". As it is avoidable, structural violence is a high cause of premature death and unnecessary disability. Because structural violence affects people differently in various social structures, it is very closely linked to social injustice. Structural violence and direct violence are said to be highly interdependent, including family violence, gender violence, hate crimes, racial violence, police violence, state violence, terrorism, and war.

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Global health Health of populations in a global context

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Critical medical anthropology (CMA) is a branch of medical anthropology that blends critical theory and ground-level ethnographic approaches in the consideration of the political economy of health, and the effect of social inequality on people's health. It puts emphasis on the structure of social relationships, rather than purely biomedical factors in analyzing health and accounting for its determinants.

Population health

Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group". It is an approach to health that aims to improve the health of an entire human population. This concept does not refer to animal or plant populations. It has been described as consisting of three components. These are "health outcomes, patterns of health determinants, and policies and interventions". A priority considered important in achieving the aim of Population Health is to reduce health inequities or disparities among different population groups due to, among other factors, the social determinants of health, SDOH. The SDOH include all the factors that the different populations are born into, grow up and function with throughout their lifetimes which potentially have a measurable impact on the health of human populations. The Population Health concept represents a change in the focus from the individual-level, characteristic of most mainstream medicine. It also seeks to complement the classic efforts of public health agencies by addressing a broader range of factors shown to impact the health of different populations. The World Health Organization's Commission on Social Determinants of Health, reported in 2008, that the SDOH factors were responsible for the bulk of diseases and injuries and these were the major causes of health inequities in all countries. In the US, SDOH were estimated to account for 70% of avoidable mortality.

Health geography

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Michael Marmot Professor of Epidemiology and Public Health

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While epidemiology is "the study of the distribution and determinants of states of health in populations", social epidemiology is "that branch of epidemiology concerned with the way that social structures, institutions, and relationships influence health." This research includes "both specific features of, and pathways by which, societal conditions affect health".

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Deficient sanitation systems, poor nutrition, and inadequate health services have pushed Haiti to the bottom of the World Bank’s rankings of health indicators. According to the United Nations World Food Programme, 80 percent of Haiti’s population lives below the poverty line. In fact, 75% of the Haitian population lives off of $2.50 per day. Consequently, malnutrition is a significant problem. Half the population can be categorized as "food insecure," and half of all Haitian children are undersized as a result of malnutrition. Less than half the population has access to clean drinking water, a rate that compares poorly even with other less-developed nations. Haiti’s healthy life expectancy at birth is 63 years. The World Health Organization (WHO) estimates that only 43 percent of the target population receives the recommended immunizations.

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The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a "toxic combination of bad policies, economics, and politics". Daily living conditions work together with these structural drivers to result in the social determinants of health.

Thomas McKeown (1912–1988) was a British physician, epidemiologist and historian of medicine. Largely based on demographic data from England and Wales, McKeown argued that the population growth since the late eighteenth century was due to improving economic conditions, i.e. better nutrition, rather than to better hygiene, public health measures and improved medicine. This became known as the "McKeown thesis".

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  1. 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.
  2. 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.CS1 maint: Multiple names: authors list (link)
  3. Kieran Walshe; Judith Smith (1 September 2011). Healthcare Management. McGraw-Hill Education (UK). pp. 261+. ISBN   978-0-335-24382-2.
  4. 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)
  5. Anderson, Matthew; Smith, Clyde Lanford (Lanny) (2013-11-03). "Honoring Vic Sidel". Social Medicine. 7 (3): 117–119. ISSN   1557-7112.
  6. 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.
  7. Howard., Waitzkin (2000). The second sickness : contradictions of capitalist health care (Rev. and updated ed.). Lanham, Md.: Rowman & Littlefield. ISBN   9780847698875. OCLC   42295890.
  8. 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.
  9. 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.
  10. 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.
  11. 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.