At the beginning of the last century, the famous German doctor Alfred Grotjan conducted the first course of lectures on medicine as a subject that examines the influence of social factors on public health. He raised questions about birth control, alcoholism, sexually transmitted diseases, becoming one of the founders of the science of public health. The work of Grotjan and his associates received a response and began to spread rapidly in many countries. This led to the fact that the development of social medicine had a powerful leap in the twentieth century. Nevertheless, the content of the subject itself is still the subject of scientific controversy. So, what is social medicine, what does it study, and what tasks is it ready to solve, let's try to figure it out.
The concept of social medicine
The issue of public health is a priority in the system of state values, since it is a powerful economic potential and resource that allows us to ensure the appropriate level and safety of life, and therefore, its further development. Public health is shaped by the effects of social, behavioral, biological, genetic, and other factors, some of which may carry a serious risk of disease risk. Based on the foregoing, the tandem of social work and medicine is of great importance.
Social medicine is a discipline about the health of society, about all kinds of methods for strengthening and maintaining it, as well as improving medical and social assistance.
The term "social medicine" was first used by French scientists Rach and Farco in the middle of the XIX century. In England, noting the difficult conditions of workers, this definition was used by sanitary inspectors E. Chadwick and J. Simon. In a Russian publication, it was noted by the Zemstvo doctor V.O. Portugalov, a public figure and revolutionary.
The subject of social medicine
The general opinion of leading social hygienists determines that the goal of studying social medicine is public health, namely the processes of its formation, influencing factors, methods of assessment, and so on. In other words, within the framework of the healthcare system, this subject studies and eliminates the problems of the impact of social, economic, and sociological conditions on public health. His focus will not be on individuals, but on society as a whole or on targeted social groups.
From the above it follows that both social and clinical medicine are associated with the health and diseases of people, solving some problems with different approaches and methods. If clinical medicine is concentrated on the diseases themselves, then social medicine is focused on the problems that cause these diseases and accompany them.
Main directions
Social medicine is the result of combining theoretical and practical medicine, disease prevention, social diagnostics, sociology, anthropology, statistical forecasting and other natural sciences. Its main areas and objects are:
- characteristic of the disease and social pathology;
- diagnosis of social diseases and pathologies;
- the spread and transmission of social diseases and pathologies;
- pathological abnormalities of certain communities;
- organization of medical and social work ;
- social hygiene (food, labor, communal living, public toilets, etc.);
- socio-medical ecology;
- healthcare organization.
Today, special emphasis is placed on socio-medical ecology and diagnostics, which allow timely identification of pathologies in social groups and individual citizens.
Sections of social medicine
The structure of social medicine consists of several sections, each of which represents a separate independent direction.
- Public medicine is aimed at maintaining the quality of life and health of both the nation as a whole and each person. It solves the problems of deteriorating health and living standards of individuals who have experienced violence, terror or certain diseases. Also in the framework of this section, the prevention of unwanted situations is carried out, the problems of family and marriage are solved.
- Penitentiary medicine studies places of deprivation of liberty (closed societies). Its activity is especially relevant in the context of modern democracy and the emergence of a high level of genetic mutations, as a result of which people with a sociopathic character are increasingly found.
- Military social medicine examines the moral and psychophysical state of participants in military campaigns and military operations, the estimated performance of people and the area of operations. Currently, social medicine in this section is at the stage of formation and development of methods for finding and providing assistance to injured persons.
- Sociological medicine studies, analyzes and analyzes obscure and complex medical phenomena. For example, the total aging of the population or the increased number of people suffering from Alzheimer's disease. Among other things, she is engaged in research of scientific and practical achievements in the field of medical genetics and electronic technologies, which can significantly affect the organization of modern societies.
Research methods
In the work of social medicine, a variety of approaches and research methods are used, the results of which will determine further health measures.
- The statistical method is the leading method in the assessment of public health, it is based on state and departmental reporting.
- The examination method is used in medical institutions to establish the quality and effectiveness of treatment.
- The demographic method is used to identify the needs of society in outpatient and inpatient care.
- The historical method evaluates events and facts in relation to time and space.
- The sociological method studies the living and working conditions of citizens, identifies risk factors.
- The economic method ensures the efficient use of health resources.
- The experimental method searches for rational forms of work of medical institutions, checks hypotheses and projects.
In addition, such approaches as modeling, forecasting, epidemiology and others are often used.
A bit of history
The foundations of social medicine were laid back in the civilizations of the Ancient World, when healers were not limited only to medical care, but also carried out sanitary control of the condition of wells, markets, public baths, the funeral procedure and oversaw the neighborhoods of the poor. Under the Egyptian pharaoh Akhenaten, concepts such as pain, illness, health were first formed, and the profession of a doctor gained social status.
In the Middle Ages, the rapid spread of infectious diseases prompted local communities to adopt and legislate a number of measures to eliminate epidemic foci: isolation of patients, burning houses and things of the diseased, quarantine of settlements, the establishment of leper colony and more. In the XVI-XVII centuries, the works of Tommaso Campanella and Thomas More were able to draw the attention of society to the importance of a healthy lifestyle, hygiene and nutrition. A significant place in the history of social medicine is the work of the Italian doctor Bernardino Ramazzini, who was engaged in the study of occupational diseases in artisans.
In 1784, the term “medical police” was introduced in Germany, the concept of which included inspection of hospitals and pharmacies, monitoring public health and preventing epidemics. In France, the issue of public health began to be considered as a national resource during the Great Revolution, as a result of which laws were adopted and reforms were introduced. In England, in 1848, a public health department was formed and a law was passed. At the same time, the leading world powers signed the first agreements on ways to combat infectious diseases.
At the turn of the XIX and XX centuries, social medicine was finally established as a scientific discipline.
The development of domestic medicine
The history of domestic social medicine has something in common with the general history. Initially, the leading role in social assistance was played by the church, which took care of the suffering co-religionists. Human suffering was not alien to the monarchs either. Tsar Ivan the Terrible spoke about state aid to the destitute (1551), he argued that hospitals, shelters and almshouses should be in every city. A tangible contribution to public medicine was made by Peter I, creating a network of social institutions and requiring the city magistrates to have hospitals. Under Catherine II, territorial aid institutes were also established.
The Zemstvo reform of 1864 contributed to the further progress of social medicine, on the basis of which the Zemstvo was responsible for "public health." The result of the reforms was the organization of medical care on a district basis.
It should also be noted that the main investments in the formation, development and solution of problems of social medicine belonged to the works of some people who worked in this area. These are M.V. Lomonosov, S. G. Zybelin, I. L. Danilevsky, E. O. Mukhin, S. P. Botkin, M. Ya. Mudrov, E. T. Belopolsky, F. F. Erisman and N. A. Semashko.
Today's challenges
Social medicine, in addition to protecting the health of society, is also responsible for its social well-being, being a direct guardian of the social protection of the population. Her tasks include:
- study of the impact of citizens' lifestyle and socio-economic factors on the health of individual groups and society as a whole;
- Argumentation of measures taken to minimize or eliminate the effects of negative environmental factors;
- creating conditions for a high level of medical care for all categories of citizens;
- programs to improve health and increase active longevity of all members of society.
The main functions of social medicine are, first of all, the protection and preservation of public health in any political, ideological, socio-economic, natural and other circumstances.