The concept of social medicine was developed in the first half of the 20th century in continental Europe. In the wake of Industrial Revolution it was found that poor working conditions, periodic economic slumps, joblessness, lack of housing facilities, destitution and poverty all created an environment that had a significant impact upon people’s health.
Qualitative studies of mortality in England revealed a higher death rate among the labourers, mechanics, servants and their families. During the years 1817 to 1821 the average annual mortality rate ranged from 22 deaths per 1000 inhabitants in the richest district to 42 deaths per 1000 inhabitants in the poorest districts of France.
Findings such as these led the great pathologist Rudolf Virchow [1821-1902] together with his colleagues in the German Medical Reform Movement of 1848, to enunciate the basic principles of social medicine as follows: first, the health of the people is a matter of direct social concern; secondly, social and economic conditions have an important effect on health and disease, and these relations must be subjected to scientific investigation; and thirdly steps must be taken to promote health and to combat disease, and the subsequent measures involved in such action must be social as well as medical.
After World WAR II a strong movement for social medicine developed in the United States. However, the term was not adopted by American Medical Schools because of the old fashioned views of the medical profession. The first Chair of social medicine was founded in Oxford along with the Institute of Medicine under Dr. Ryle as Director and first Professor of Social Medicine. At that time, social sciences were identified as having ‘humanitarian and utilitarian motives’ which fitted in with the emphasis of social medicine on social and political solutions to social problems.
As a matter of fact the intention of social medicine is 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 healthier society.
The introduction of “social” factors into medical explanation was most strongly evidenced in branches of medicine closely related to the community. Since its inception as the public health movement of the 19th century social medicine had strong links with the problems of urban living tending to seek solutions in social and political action rather than in recourse to the laboratory.
At the same time a social diagnosis is an integral part of social medicine which involves social evidence about the patient and his immediate family. The most pertinent factors about patient’s family history and the surroundings when taken together give a holistic picture of the patient concerned in relation to the social problems to be taken up such as illness, maladjustment, living conditions, pollution, poverty and so on so forth. This kind of identical social problem is being confronted by the three-fourth poverty ridden men and women of the developing nations of the globe who are either socio-economically dismissed or forced to live in sub-human conditions.
As far as the problem with our healthcare system is concerned, there is no denying that it is multifactorial. First, the side effects of biomedicine [read antibiotics] are known to even lay persons. Secondly, the irrational prescription of drugs by doctors is also responsible for the everyday loss of life, and lastly unethical marketization of medical profession has created enormous problems particularly for the have-nots of this country
Therefore, barring treatment of some of the life threatening diseases, social medicine could be an adequate substitute for biomedicine in order to ensure physical, mental, intellectual and spiritual wellness to all, without any ifs and buts.