The field of social medicine seeks to:
- understand how social and economic conditions impact health, disease and the practice of medicine and
- 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 , Victor Sidel, Howard Waitzkin, and more recently Paul Farmer and Jim Yong Kim.
In The Second Sickness, Howard Waitzkin traces the history of social medicine from Engels, through Virchow, through Allende. Waitzkin has sought to educate North Americans about the contributions of Latin American Social Medicine.
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. McKeown was heavily criticized for his controversial ideas, but is nowadays remembered as ‘the founder of social medicine’.
The major emphasis on biomedical science in medical education, 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:
‘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’.
The field of social medicine is most commonly addressed today by public health efforts to understand what are known as social determinants of health.