Archive for the 'About Social Medicine' Category

Social Medicine Course (in Spanish)

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Our colleagues in the Latin American Association of Social Medicine (ALAMES) have organized a distance learning course on Social Medicine.  Many of the classes are taught by leaders of Latin American Social Medicine. Its a rare opportunity to hear their approach to social medicine.  The structure and objectives of the course are detailed in this video:

The course will take place in Spanish. If you are interested in enrolling, you can do so at this link. Matt Anderson, MD
bronxdoc@gmail.com

2014 Einstein Student Run Social Medicine Course

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The Social Medicine Course at the Albert Einstein College of Medicine was founded by a group of 8 students in 1998 and is now in its 17th year. It remains entirely student-run. Course schedules going back to 2007 can be accessed at this page on the Portal.  The talks run from 5:30 to 6:30PM and take place on the 5th floor Forchheimer Lecture Room. They are open to the public.

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Wednesday, January 8, 2014
Dr. Robert E. Fullilove
Health and Racial Disparities in New York City

Wednesday, January 15, 2014
Dr. Sunil Kumar Aggarwa
Compassionate Care: Medical Marijuana In New York

Wednesday, January 22, 2014
Dr. Marji Gold
Reproductive Rights and Abortion Care

Wednesday, January 29, 2014
Dr. Oliver Fein
Direct Action: Lessons from the Young Lords Occupation of Lincoln Hospital

Wednesday, February 5, 2014
Mychal Johnson South Bronx Unite:
FreshDirect and its Health and Social Costs in the South Bronx

Wednesday, February 12, 2014
TBA

Wednesday, February 19, 2014
Dr. Maria Caban
Harm Reduction and Syringe-Exchange in the South Bronx

Wednesday, February 26, 2014
TBA

Wednesday, March 5, 2014
Dr. Mark Heath
Bioethics of Lethal Injection

Wednesday, March 12, 2014
Dr. Rosy Chhabra
Community Based Participatory Research

Wednesday, March 19, 2014
Dr. Danny Lugassy
Healthcare Reform in 2014: Why do we still need Single Payer?

Wednesday, March 26, 2014
Dr. Neil Calman
Segregated Health Care in the South Bronx

Wednesday, April 2, 2014
Dr Aaron Fox
Prison Medicine

Wednesday, April 9, 2014
Dr. Nancy Berlinger
Access to Healthcare for Undocumented Immigrants

Wednesday, April 30, 2014
Dr. Alan Blum
Ending The World Tobacco Pandemic

posted by Matt Anderson, MD

Cuba Leads the World in Lowest Patient per Doctor Ratio; How do they do it?

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by Joanna Mae Souers

*Paraguayan 5th year student participating in primary care in Havana, Cuba. (2011,by Joanna Mae Souers)

In early 2007, I began studying medicine at the Latin American School of Medicine in Havana, Cuba.  I entered the program not knowing much about the Cuban healthcare system, other than that it was universal and free.  “Now that’s a system I want to learn from,” I thought to myself, “It’s a system we could all learn from.”  Five years later, what have I learned?

There are many subtle and not so subtle differences between the Cuban and the U.S. health care systems which have allowed the Cubans to equal the U.S. with respect to their health statistics, but at a much lower cost and with better preventative and primary care.  In this paper I analyze just one of the reasons for the differences between the two systems; Cuba produces more primary care practitioners per capita.  How do they do it? Medical education in Cuba is free, all doctors interested in specializing must first serve two years working in primary care, and graduating doctors are not driven to specialize by salary incentives.  This socialist approach towards medicine and medical education assures the human resources necessary to provide universal and preventative healthcare to all.

People marvel at how Cuba has “accomplished so much with so little.”  And they marvel with good reason.  According to the World Health Organization, Cuba spent only $503 per capita on healthcare in 2009, the U.S. spent almost 15 times that sum.  In fact we in the US spent $421 per person just on the administration of the private healthcare insurance system, almost enough to fund the Cuban system. [1] [2] Despite dramatically lower costs, Cuba has some of the best health statistics and health indicators of any country around the world.

Although people like to compare and contrast the health statistics of the U.S. and Cuba, I think this a bit preposterous.  Cuba, a small island in the Caribbean, is being compared to one of the largest countries in the Americas with a very different history.  So in the table below, I have shown some health statistics on Cuba and the U.S. as well as the Dominican Republic and Haiti.  The Dominican Republic and Haiti are Cuba’s Caribbean neighbors; similar in size, history and geographic location.

*Statistical information provided by the World Health Statistics 2011 Report by the World Health Organization.

From this table, we can see that Cuba’s health indicators are more like those of the “first world” in the U.S. than its neighbors in the “third world.”  The life expectancy of the U.S. and Cuba is almost identical.  Cuba supersedes the U.S. in the categories highlighted.  So we continue to ask, “How do they do it?”  Could it have something to do with their philosophy that people need doctors?  Hence, their solution is to offer a free medical education to develop young, quality doctors dedicated to serving those in need.

Per capita Cuba graduates roughly three times the number of doctors as the U.S.   In 2005 Cuba had 70,594 doctors.  Before the revolution in 1959, there were only an estimated 6,000 doctors; somewhere around half left the country after 1959.  This means they must have graduated an average of 1,469 Cuban doctors per year, not including the some 5,000 international students who graduate each year from Cuban medical schools. [3]  When we later compare these numbers to the U.S. we see that Cuba graduates 3 times the number of doctors per capita, and the U.S. must import graduating doctors from other countries just to fill the primary care residency positions.

Critics of the “Obama Plan” say that there will not be enough doctors in the U.S. to take care of all the patients if everyone has healthcare coverage.  Obama encouraged the Association of American Medical Colleges to increase the number of graduating doctors by 30% in 2010.  Ever since 1980, U.S. Medical schools have graduated 16,000 doctors a year.  Meanwhile, the population of the U.S. has grown 50 million during the same period.[4]  A 30% increase would have meant we should have graduated 20,800 medical students in 2010, but we only graduated 16,838 according to the Kaiser Family Foundation.[5]  The number of residency programs at teaching hospitals in the U.S. has been frozen since 1997, funded by Medicare.  There were 29,890 residency slots filled in 2009,positions not filled by American graduates are filled by International Medical Graduates. [4]   This means we can estimate more than 1/3 of students in U.S. residency programs are International Medical Graduates (IMGs), students from another country or a U.S. citizen, like me, who studied in another country.

In the current scheme of things, International Medical Graduates are continuously brought in to the U.S. to meet the needs of the growing patient population.  Unfortunately nothing bridges the gap, because there just are not enough residency positions and/or funding for teaching hospitals to produce enough doctors to satisfy the entire U.S. population.  Taking International Medical Graduates to meet the needs of the U.S. population only adds to the “brain drain” of developing countries around the world.  So as we produce fewer doctors, introduce more doctors from other countries; U.S. doctors work harder for less to meet the needs in the U.S. and a lot of the world remains catastrophically underserved.

Cuba leads the world with the lowest patient to doctor ratio, 155:1, while the U.S. trails way behind at 396:1.[6]  With a surplus of Cuban doctors, Cuba is able to help ailing nations around the world.  They have medical missions in over 75 different countries lead by nearly 40,000 health professionals, almost half of them are doctors.[7]  The United States by contrast imports doctors from poorer countries, further contributing to the brain drain of professionals from poorer countries to rich ones.

In Cuba education is free.  Room and board, books and amenities are included.  Doctors are not burdened by student loans and live comfortably though not extravagantly.  Harvard Medical School states in their admissions statement that an “un-married first year medical student” will spend approximately $73,000 for the 2011-2012 academic year.  This includes tuition, room and board, books, etc.[8]  Now times that by four and you have a whopping $292,000 to shell out to become a Harvard doctor.  With interest rates, loan deferments and default charges, you might end up like Michelle Bisutti.  She graduated medical school in 2003 with a $250,000 debt, in which by 2010 had increased to $555,000.[9] This may be an extreme case, but the Association of American Medical Colleges projected in their 2007 report that in 2033, students on a 10-year repayment program will only see half of their after-taxes salaries, the rest going to loan repayment.[10]

The cost of medical education in the U.S. causes more and more medical school graduates to turn to higher paying specialties and subspecialties rather than primary care or family medicine.  Dr. Thomas Bodenheimer writing for the New England Journal of Medicine, stated that “between 1997 and 2005, the number of U.S. graduates entering family practice residencies dropped by 50 percent,” based on data from the National Resident Matching Program. [11]  In the U.S. specialists predominate at a ratio of 2:1 (the reverse of other Western countries) while half of all outpatient visits are made by primary care physicians. [12]   This deficit of primary care physicians decreases people’s access to primary care and preventative medicine, causing increases in health disparities and healthcare costs.  This is because preventative medicine benefits the patient as well as reduces the number of Emergency Department visits and hospital stays.  If there are no primary care physicians to provide preventative care to the population, we see the population suffer as costs continue to rise.

* Family Medicine Residency Positions and Number Filled by U.S. Medical School Graduates. From the American Academy of Family Physicians, based on data from the National Resident Matching Program. [11]

According to a survey in 2008 by the American Academy of Family Physicians, family medicine graduates with less than 7 years of experience earn, on average, a yearly salary of $145,000.[13]  The difference in earnings between primary care physicians and specialists differed by only 30 percent in 1980, and dramatically rose up to 300 percent for some narrowly defined specialists by 2009.  In the graph below, we show the dramatic difference between median compensation for selected specialties compared to that of primary care.[14,15]

*Median Compensation for Selected Medical Specialties.
Data are from the Medical Group Management Association Physician Compensation and Production Survey, 1998 and 2005. [15]

When working in the U.S., almost every primary care physician I talk to has the same complaint, “Too many patients, and too little time.”  They are forced to see 20 to 30 patients a day just to meet pay-incentives and “keep their doors open.”  General/Family Practice physicians spend an average of 16.1 minutes with each patient per visit. [16]   Meanwhile, 18%, or roughly 48.2 million of the U.S. population under the age of 64 is without healthcare insurance.  They have no access to most GP’s or family practice physicians. [17]

We need to follow our Cuban role model, we need to be held socially accountable and produce more primary care physicians.  This can be accomplished by providing an education at full scholarship to those interested in primary care, or by increasing the number of medical students going into primary care by closing the compensation gap between primary care and the higher paid specialties.  These measures would ensure the population better access to quality primary care and preventative medicine.  It would bring down the cost of healthcare while allowing primary care physicians to practice under less stressful conditions leading to quality affordable healthcare for all.

 

  1. World Health Organization (WHO 2011); Countries. [www.who.int/countries/en]
  2.  “Healthcare Marketplace Project, Trends and Indicators in the Changing Marketplace (Exhibit 6.11: Private Health Insurance Admin Cost per Person Covered, 1986-2003),” Kaiser Family Foundation, Publication Number: 7031.  [http://www.kff.org/insurance/7031/print-sec6.cfm]
  3.  “Cuba and the Global Health Workforce: Training Human Resources.” Salud! (Source Vice Ministery for Medical Education and Research, Ministry of Public Health) [http://www.saludthefilm.net/ns/elam.html]
  4. Sullivan, Paul.  “Discomfort at U.S. Medical Schools.” The New York Times; April 29, 2009.
  5.  “Total Number of Medical School Graduates, 2010.”  The Kaiser Family Foundation.  [http://www.statehealthfacts.org/comparemaptable.jsp?ind=434&cat=8]
  6.  “World Health Statistics 2011,” World Health Organization; WHO Press, Switzerland.
  7. Brouwer, Steve.  “The Cuban Revolutionary Doctor: The Ultimate Weapon of Solidarity,” Monthly Review, 2009, vol 60, issue 8 (January).
  8. Harvard Medical School Admissions, “Costs (Updated: 7/21/2011).”  [http://hms.harvard.edu/admissions/default.asp?page=costs]
  9. Pilon, Mary.  “The $555,000 Student Loan Burden,” The Wall Street Journal, February 13, 2010.
  10. Fuchs, Elissa.  “With Debt on the Rise, Students Face an Uphill Battle.” The Association of American Medical Colleges, January 2008.
  11. Bodenheimer, Dr. Thomas,“Primary Care – Will it Survive?” New England Journal of Medicine, vol 355;9. Pg 861-862.
  12. Alper, Philip R. “Primary Care’s Dim Prognosis,” Hoover Institution, Stanford University, Policy Review No. 158 (December 1, 2009).
  13. American Academy of Family Physicians, Income (2011).      [http://www.aafp.org/online/en/home/publications/otherpubs/debtmgmt/graduation/income.html]
  14. Alper, Philip R. “The Decline of the Family Doctor,” Hoover Institution, Stanford University, Policy Review No. 124 (April 1, 2004).
  15. Woo, Dr. Beverly.  “Primary Care – The Best Job in Medicine?” New England Journal of Medicine, vol 355;9. Pgs 864-866.
  16.  “Healthcare Marketplace Project , Trends and Indicators in Changing Healthcare Marketplace (Exhibit 6.5: Mean Time Spent with Physicians (in Minutes), 1989 – 2002),”  Kaiser Family Foundation, Publication Number: 7031, Information Updated: 4/11/05.      [http://www.kff.org/insurance/7031/print-sec6.cfm]
  17.  “2010 National Health Interview Survey (Tables 1.1A-B, 1.2 B)”, Center for Disease Control.  [http://www.cdc.gov/nchs/fastats/hinsure.htm]

 

Reminder: Social Medicine Course in Northern Uganda – Applications Due June 30th

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SocMed invites students to apply for the fourth annual course Beyond the Biologic Basis of Disease: The Social and Economic Causation of Illness, a social medicine immersion experience conducted on-site at Lacor Hospital in Gulu, Uganda from January 7, 2013 to February 1, 2013. This unique immersion course incorporates innovative teaching methodologies to merge teaching of clinical tropical medicine with understanding the socioeconomic, cultural, political, and historical underpinnings of illness. Through a combination of lectures, small and large group discussions, films, community field visits, ward rounds, and clinical case discussions, the study of clinical medicine in a resource-poor setting is intersected with social medicine topics such as the social determinants of health, globalization, war, human rights, community-based health care, and narrative medicine. Enrollment is open to fifteen 3rd and 4th year medical students from across the globe, and includes equal participation of Ugandan medical students, and credit for away-rotations can be arranged.

 

This course is offered through SocMed, an organization that advocates for and implements global health curricula founded on the study of social medicine. By engaging medical students though careful examination of the social and economic contexts of health and immersing them in partnership with a diverse group of students from around the world, we aim to foster innovative leaders who are ready to tackle challenging health problems in communities around the world.

SocMed utilizes a curriculum that places great importance on building personal partnerships and encouraging students to reflect upon their personal experiences with power, privilege, race, class, gender, and sexual orientation as central to effective partnership building in global health. In the spirit of praxis (a model of education that combines critical reflection with action) these components of the course give students the opportunity to discern their role in global health and social medicine through facilitated, in-depth conversations with core faculty and student colleagues.  Please feel free to visit our website, www.socmedglobal.org, for more information about the course, its directors and guest lecturers, and SocMed.  Applications are due by June 30, 2012.

 

Please do not hesitate to contact us with any questions you have at inquiries@socmedglobal.org

 

Sincerely,

 

Michael Westerhaus, MD, MA

Amy Finnegan, Ph.D.

Course Directors

Research Based Health Activism 2009 – Medical Student Elective

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Research-based health activism describes a growing sector of the medical and public health worlds where the classic skills of clinical research and epidemiology are combined with grass-roots advocacy to influence federal and state health policy, counteracting the influence of private industry and market forces on public and community health. The Residency Program in Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine has a rich tradition of innovations in community oriented primary care and a history of progressive research and practice. Our faculty, together with experts from throughout the New York Metropolitan area, will provide training in this growing field of research-based health activism.

In October 2009, we will offer a one month elective for 4th year medical students interested in research based health activism. The course, now in its 8th year, combines both didactic and project based approaches, culminating with a research proposal that students can complete at their home institutions.

The didactic lectures will introduce three major topic areas: research methods, health policy, and advocacy skills. Individual and small group mentorship will be provided to help students utilize these skills by developing their own independent research proposal. Other sessions will include physician-activist guest lecturers and visits to state or private health organizations that both create and influence health policy.

Finally, students will develop a research proposal for a project reflecting their interests and an advocacy plan to gain the maximum health policy impact with the results. This proposal will be presented on the final day of the course at a luncheon including all students, the course directors, returning session leaders, and Peter Lurie, MD, MPH, from the Public Citizen’s Health Research Group.

FACULTY AND RESIDENTS:
*Aaron Fox, MD, Clinical Instructor of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Course Director, Research-Based Health Activism Course;
*Viraj Patel, MD, Primary Care Resident, Montefiore Medical Center

FOR MORE INFORMATION: Please contact Aaron Fox, MD at this link: Aaron Fox

Past Programming Tracks:

Health Policy and Activism—The history and the present: Bertrand Bell, MD: Making Real World Change As A Physician—Jo Ivey Boufford, MD: Public Policy—Joseph Ross, MD: Health Care Organization—Ernest Drucker, PhD: A Plague of Prisons: The Epidemiology of Mass Incarceration—Oliver Fein, MD: National Health Insurance for the US: Has Its Time Come?—Paul Lipson, Chief of Staff and Siddharta Sanchez, Community Liaison for Immigration & Environmental Affairs for Bronx Congressman José Serrano: Health Topics as they relate to the policies in the Bronx, NY—Ruth Macklin, PhD: Research Ethics: Protecting Human Subjects of International Research—Eva Metalios, MD: Human Rights Clinic—Barbara Seaman: Women’s Health Activism—Peter Selwyn, MD, MPH: Research and Advocacy at the Dawn of AIDS—Peter Sherman, MD: The Affects of Domestic Violence on Children—Victor Sidel, MD: Social Injustice and Public Health, and War, Terrorism, and Public Health—Hal Strelnick, MD: Health Policy at Local, State, and National Levels—Bruce Vladeck, PhD: Medicare and the Role of Physicians in the Future—Sidney Wolfe, MD: Research Topics/Questions

Research Methods—how to produce activist research:

Matthew Anderson, MD, MSc: Planning the write-up process of your project—Chinazo Cunningham, MD: Grant Writing—Robin Flam, MD, DrPH: Uses of Epidemiology—Aaron Fox, MD: Social Epidemiology—Nerina Garcia, PhD and Lucia Ferra: Qualitative data use and analysis—Alison Karasz, PhD and Galit Sacajiu, MD, MPH: The Underline Construct—Paul Meissner, MSPH: Using Secondary Demographic and Clinical Databases—Robert Roose, MD: Quantitative data use and analysis—Galit Sacajiu, MD, MPH: Research Questions—Nancy Sohler, PhD, MPH and Galit Sacajiu, MD, MPH: Study Designs

Advocacy—how to create change:

David Appel, MD: Lobbying—Ramin Asgary, MD, MPH, MSc:Humanitarian Assistance: The Principles—Oni Blackstock, MD: HIV/AIDS in Ghana: Adherence and Stigma—Bob Goodman, MD—Pharmaceutical Industry and Physicians—Kirsten Goodwin of GMHC: Coalition Building—Hillary Kunins, MD, MPH, MS and Carolyn Chu, MD: Case Workshop: Advocating for Choice—Janice Lieberman, NBC Studio: Media Relations in Health Research and Advocacy—David Matthews: Harm Reduction and HIV: a grass root organization—Steve Max of Midwest Academy: Intro to Organizing and Strategy Building—Mini Murthy, MD, MPH, MS: Women’s Health and Human Rights—Zena Nelson: The South Bronx Food Cooperative—Adam Richards, MD, MPH: Public Health and Human Rights Praxis in Burma—Minesh Shah, MD: Public Speaking—Lanny Smith, MD, MPH, DTM&H: Liberation Medicine, Health and Human Rights—Leonora Tiefer, PhD: FSD-A Case of Disease Mongering and Activist Resistance

Click on the links below for:

Course Brochure 2009
An application for the course:  2009 application
Articles about the course from the journal of general internal medicine, Academic Physician and Scientist and the New York Times

Aaron Fox, MD

Social Medicine and Public Health: Webcast from the Clinical Directors Network

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On March 11th, 2009 I had the privilege of speaking with Dr. Victor Sidel in a webcast at the Clinical Directors Network.   Our topic was Social Medicine: Bridging Primary Care and Public Health and we were interviewed by Dr. John Tobin, the President of the Clinical  Directors Network (CDN).

The CDN was established in 1985 by professionals working in Community Health Centers. It was initially a practice-based research network, but  has since expanded to taking on a number of additional roles including educational and quality improvement programs and the development of eClinician.org.

To view the webcast please go to the following link.   (The slides can be downloaded from this page.)  Clicking the title of the talk opens up a Wimba Classroom page. Sign in as a participant using any name you choose.  This will – after a bit of time – take you to the webcast.  If you would like CME credit, please contact CDN at info@CDNetwork.org.

posted by Matt Anderson, MD

Social Medicine Building Bridges @ the APHA Annual Meeting 10/27/2008

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The theme of the 2008 annual meeting of the American Public Health Association (APHA) is “Public Health without Borders.”  We are very pleased that the APHA Medical Care Section has chosen to sponsor a session examining how social medicine can help build bridges between progressive health movements in  North America and Latin America.  We reprint below the abstract from the conference program which contains links to individual presentations.  We are told this is the first time in the history of the APHA that abstracts have been printed in more than one language.

Medicina Social and Social Medicine:

A Framework for Bridging Borders

Monday, October 27, 2008: 2:30 PM

The APHA Medical Care Section founders viewed social medicine as a model for bridging the divide between clinical care and public health. This session explores how social medicine can serve as a framework for collaboration between medicine and public health and between North and South. In a 2006 article discussing the future of social medicine, historian Dorothy Porter pointed to the need to integrate “the historical wisdom acquired during the evolution of the discipline into a new framework … for understanding the complex interaction of biology with the political, economic, social, and cultural relations of the twenty-first century.” In accomplish this integration Dr. Porter proposed cooperation between the Anglo-American social medicine tradition and that of Latin American social medicine (LASM). Concomitantly, the Department of Family and Social Medicine at Montefiore Medical Center initiated a unique partnership with the Latin American Social Medicine Association (ALAMES) creating a bilingual, open-access, online journal (Social Medicine/Medicina Social) utilizing the Open Journal System (Simon Frazier University). This session will discuss key papers published in the journal and explore possibilities for collaboration between Latin American and North American healthcare workers.

Session Objectives: Recognize and discuss the unique experience of social medicine in combining personal medical care with a public health perspective. This objective will be accomplished by a consideration of “classic” papers in social medicine. Learn about Latin American approaches to issues raised in current public health debates in the United States. This objective will be accomplished by discussing Latin American analysis and approaches to health equity. Learn about and consider the application of new technologies (such as electronic publishing) to the development of cross-border collaboration and the ability of such technology to create a space for new voices in public health debates. This objective will be accomplished by the presentation of the development of a bilingual, eJournal of Social Medicine (www.socialmedicine.info) and the UNM Latin American Social Medicine database.

Organizers:

Victor W. Sidel, MD and Matthew Anderson, MD, MSc

Moderator:

Anne-Emanuelle Birn, MA, ScD

Discussant:

Nancy Sohler, PhD, MPH

2:30 PM

Social Medicine as a Builder of Bridges / La medicina social como constructora de puentes
Victor W. Sidel, MD and Peter Selwyn, MD, MPH

2:40 PM

Development of a Bilingual Online Journal of Social Medicine/Desarrollo de una revista electrónica de medicina social
Matthew Anderson, MD and Florencia Peña, PhD

2:50 PM

Latin American Social Medicine Database: A Resource for Public Health/ La Región de América Latina Base de Datos de la Medicina Social: Un Recurso para la Salud Pública
Howard Waitzkin, MD, PhD

3:00 PM

A Practice of Social Medicine / Una Práctica de Medicina Social
H. Jack Geiger, MD, MSciHyg

3:10 PM

Social Medicine in Chile / La Medicina Social en Chile
Roberto Belmar, MD

3:20 PM

Contribution of Latin American Social Medicine to U.S. Debates on Health Equity/ Contribuciones de la Medicina Social Latinoamericana al debate sobre la igualdad en salud en los Estados Unidos
Celia Iriart, MPH, PhD

3:30 PM

Discussion: Nancy Sohler to moderate

See individual abstracts for presenting author’s disclosure statement and author’s information.

Organized by: Medical Care
Endorsed by: Community Health Workers SPIG, International Health, Peace Caucus, Socialist Caucus

This was posted by Matt Anderson, MD

What is Social Medicine?

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This is a question we hear all the time from students. This site has been created by faculty at the Department of Social and Family Medicine at AECOM to answer that question. The Social Medicine Portal will showcase the many aspects of social medicine and the incredible breadth of the movements inspired by it.

It is possible to argue that all medicine by its very nature is social. The way we define diseases and health, the methods we use for diagnosis and treatment, how we finance health care, all these cannot help but reflect the social environment in which medicine operates.

Social medicine, however, looks at these interactions in a systematic way and seeks to understand how health, disease and social conditions are interrelated. This type of study began in earnest in the early 1800’s. It was the time of the Industrial Revolution and it was impossible to ignore the extent to which the factory system impoverished the workers, thus creating poverty and disease.

The most famous representative of early social medicine is Rudolf Virchow, the distinguished German pathologist who developed the theory of cellular pathology. Virchow was also a social reformer who remarked that “politics is nothing more than medicine on a grand scale.” In the 20th century George Rosen would distill the Virchow’s principles into the following:

  1. Social and economic conditions profoundly impact health, disease and the practice of medicine.
  2. The health of the population is a matter of social concern.
  3. Society should promote health through both individual and social means.

As might be gathered from these ideas, social medicine was not simply an academic pursuit. Its practitioners were political reformers, radicals, activists. Virchow believed that the “physician was the natural advocate for the poor.” And this defense of social justice would stamp future generations of physicians and health care workers. Social medicine has grown and developed in many different ways in the past two centuries. At times it has seemed as if the “biomedical paradigm” would make social issues in medicine irrelevant. Yet we cannot escape the reality that we are social animals and our diseases occurs in “social animals” and not in test-tubes. The current debate over HIV treatment access illustrates both the astounding success and spectacular failure of modern biomedicine. Why is it that most AIDS patients will simply not get the medications that can save their lives?

You can read a fuller explanation of these ideas in our paper “What is Social Medicine?” that was published in Monthly Review.





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