Social medicine

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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

Social medicine is an interdisciplinary field that focuses on the profound 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, 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

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 medicine is a vast and evolving field, and its scope can cover a wide range of topics that touch on the intersection of society and health. The scope of social medicine includes:

  1. Social Determinants of Health: Investigation of how factors like income, education, employment, race, gender, housing, and social support impact health outcomes.
  2. Health Equity and Disparities: Studying the disparities in health outcomes among different groups based on racial, economic, gender, or other sociodemographic factors and creating strategies to promote equal health opportunities for all.
  3. Health Systems and Policies: Evaluating how different healthcare systems, structures, and policies impact health outcomes. This includes assessing the effectiveness of public health campaigns, insurance models, and health-related legislation.
  4. Environmental Health: Understanding how environmental factors such as pollution, climate change, and access to clean water and sanitation affect health.
  5. Global Health: Addressing health concerns that transcend national borders, such as epidemics, pandemics, or the health impacts of globalization.
  6. Cultural Competency: Training healthcare professionals to understand and respect cultural differences in patient care. This involves understanding diverse health beliefs, values, and behaviors.
  7. Migration and Health: Studying the health implications of migration, whether it's due to conflict, economic reasons, or other factors. This includes looking at issues like refugee health, healthcare access for undocumented migrants, and more.
  8. Urbanization and Health: Analyzing the impact of urban living conditions, urban development, and city policies on health.
  9. Mental Health: Delving into how social factors like stigma, discrimination, social isolation, and traumatic events impact mental health and well-being.
  10. Violence and Health: Investigating the health implications of different forms of violence, including domestic violence, community violence, and structural violence, and developing strategies to prevent and address these impacts.
  11. Occupational Health: Examining the health impacts of different work environments, job roles, and organizational structures.
  12. Substance Use and Addiction: Analyzing the social determinants and implications of substance use, including policies and societal attitudes toward different substances.
  13. Community Engagement and Empowerment: Working with communities to identify their health needs, co-create interventions, and mobilize resources to promote health.
  14. Medical Education: Integrating social medicine topics into medical curricula to ensure that healthcare professionals are equipped to address the social aspects of health and illness.
  15. Interdisciplinary Collaboration: Working with professionals from diverse fields, such as anthropology, sociology, economics, and urban planning, to address complex health challenges.

Comparison with Public Health

While there is some overlap between social medicine and public health , there are distinctions between the two fields. Distinct from public health, which concentrates on the health of entire populations and encompasses broad strategies for disease prevention and health promotion, social medicine dives deeper into the societal structures and conditions that lead to health disparities among different groups. Its approach is often more qualitative, honing in on the lived experiences of individuals within their social contexts. While public health might launch broad-spectrum interventions like vaccination campaigns or sanitation drives, social medicine probes the underlying socio-economic reasons why certain communities might be disproportionately affected by health challenges. The ultimate goal of social medicine is to ensure that societal structures support the health of all members, particularly those most vulnerable or marginalized.

  1. Social Medicine:
    • Focus: Primarily on the socio-economic factors that affect health and how these can be addressed to promote better health outcomes.
    • Approach: It delves deeper into the relationship between society and individual health. This includes the impacts of discrimination, inequality, poverty, and other social determinants.
    • Historical Context: Originated during the Industrial Revolution as a response to the health challenges faced by the working class due to industrialization.
    • Goal: To use the understanding of socio-economic factors to influence healthcare practices and policy to bring about a healthier society.
  2. Public Health:
    • Focus: On the health of the general population, aiming to prevent disease and promote health at a community or population level.
    • Approach: It encompasses a broader set of tools and strategies, ranging from disease surveillance, health education, policy recommendations, and health promotion initiatives.
    • Historical Context: Has its roots in controlling infectious diseases, ensuring clean water and sanitation, and other community-wide health initiatives.
    • Goal: To improve health outcomes through community interventions, policy, and education, often utilizing epidemiological studies and data analysis.

To visualize the difference: Imagine a city facing an outbreak of a disease. A public health approach might involve vaccination campaigns, public health advisories, and quarantine measures. A social medicine approach might delve into why certain communities within the city are more affected than others, looking at housing conditions, employment status, racial or socio-economic discrimination, and other societal factors, and then proposing solutions based on these insights.

Both fields recognize the importance of the social determinants of health but approach the topic from slightly different angles and with varying emphases. In practice, there's a lot of collaboration and overlap between social medicine and public health, as both are essential for a holistic approach to health and wellness.

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 & 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 compliment 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

Related Research Articles

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<span class="mw-page-title-main">Biopsychosocial model</span> Explanatory model emphasizing the interplay among causal forces

Biopsychosocial models are a class of trans-disciplinary models which look at the interconnection between biology, psychology, and socio-environmental factors. These models specifically examine how these aspects play a role in topics ranging from human development to health and disease.

In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection.

<span class="mw-page-title-main">Community health</span> Field of public health

Community health refers to simple health services that are delivered by laymen outside hospitals and clinics. Community health is also the subset of public health that is taught to and practiced by clinicians as part of their normal duties. Community health volunteers and community health workers work with primary care providers to facilitate entry into, exit from and utilization of the formal health system by community members.

Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.

<span class="mw-page-title-main">Population health</span> Health outcomes of a group of individuals

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. It has been described as consisting of three components. These are "health outcomes, patterns of health determinants, and policies and interventions".

<span class="mw-page-title-main">Michael Marmot</span> British medicine and public health academic (born 1945)

Sir Michael Gideon Marmot is Professor of Epidemiology and Public Health at University College London. He is currently the Director of The UCL Institute of Health Equity. Marmot has led research groups on health inequalities for over thirty years, working for various international and governmental bodies. In 2023, he was elected to the American Philosophical Society.

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 or vulnerability for a disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.

Race and health refers to how being identified with a specific race influences health. Race is a complex concept that has changed across chronological eras and depends on both self-identification and social recognition. In the study of race and health, scientists organize people in racial categories depending on different factors such as: phenotype, ancestry, social identity, genetic makeup and lived experience. "Race" and ethnicity often remain undifferentiated in health research.

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".

The public healthcare system in India evolved due to a number of influences since 1947, including British influence from the colonial period. The need for an efficient and effective public health system in India is large. Public health system across nations is a conglomeration of all organized activities that prevent disease, prolong life and promote health and efficiency of its people. Indian healthcare system has been historically dominated by provisioning of medical care and neglected public health. 11.9% of all maternal deaths and 18% of all infant mortality in the world occurs in India, ranking it the highest in the world. 36.6 out of 1000 children are dead by the time they reach the age of 5. 62% of children are immunized. Communicable disease is the cause of death for 53% of all deaths in India.

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.

<span class="mw-page-title-main">Health care access among Dalits in India</span>

Achieving Universal Health Care has been a key goal of the Indian Government since the Constitution was drafted. The Government has since launched several programs and policies to realize ‘Health for All’ in the nation. These measures are in line with the sustainable development goals set by the United Nations. Health disparities generated through the Hindu caste system have been a major roadblock in realizing these goals. The Dalit (untouchables) community occupies the lowest stratum of the Hindu caste system. Historically, they have performed menial jobs like- manual scavenging, skinning animal hide, and sanitation. The Indian constitution officially recognizes the Dalit community as ‘Scheduled Castes’ and bans caste-based discrimination of any form. However, caste and its far-reaching effects are still prominent in several domains including healthcare. Dalits and Adivasis have the lowest healthcare utilization and outcome percentage. Their living conditions and occupations put them at high risk for disease exposure. This, clubbed with discrimination from healthcare workers and lack of awareness makes them the most disadvantaged groups in society.

<span class="mw-page-title-main">Women's health in India</span> Demographic health topic

Women's health in India can be examined in terms of multiple indicators, which vary by geography, socioeconomic standing and culture. To adequately improve the health of women in India multiple dimensions of wellbeing must be analysed in relation to global health averages and also in comparison to men in India. Health is an important factor that contributes to human wellbeing and economic growth.

Population health, a field which focuses on the improvement of the health outcomes for a group of individuals, has been described as consisting of three components: "health outcomes, patterns of health determinants, and policies and interventions". Policies and Interventions define the methods in which health outcomes and patterns of health determinants are implemented. Policies which are helpful "improve the conditions under which people live". Interventions encourage healthy behaviors for individuals or populations through "program elements or strategies designed to produce behavior changes or improve health status".

The weathering hypothesis was proposed to account for early health deterioration as a result of cumulative exposure to experiences of social, economic and political adversity. It is well documented that minority groups and marginalized communities suffer from poorer health outcomes. This may be due to a multitude of stressors including prejudice, social alienation, institutional bias, political oppression, economic exclusion and racial discrimination. The weathering hypothesis proposes that the cumulative burden of these stressors as individuals age is "weathering," and the increased weathering experienced by minority groups compared to others can account for differences in health outcomes. In recent years, the biological plausibility of the weathering hypothesis has been investigated in studies evaluating the physiological effects of social, environmental and political stressors among marginalized communities. This has led to more widespread use of the weathering hypothesis as a framework for explaining health disparities on the basis of differential exposure to racially based stressors. Researchers have also identified patterns connecting weathering to biological phenomena associated with stress and aging, such as allostatic load, epigenetics, telomere shortening, and accelerated brain aging.

<span class="mw-page-title-main">Health politics</span> Interdisciplinary study and analysis of health politics

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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. 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. 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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