Origin and development of social medicine as a science

Social medicine is the branch that studies the social causes of health and disease. Textbooks differ on where it sits: some call it a scientific branch of medicine, others a specialisation within the field of sociology. Both agree on its job.

• Social medicine is a scientific discipline that studies how social conditions affect health, and aims to improve public health through prevention and policy. This is sz's one-sentence definition, word for word in the Common exam questions section below.
• It studies the relationship between medicine and public health, the social factors in aetiology (the cause of disease), and the prevalence and interpretation of disease in society.
• It emerged in 19th-century Europe, when industrialisation and poor living and working conditions were seen as the root causes of disease.
• Rudolf Virchow, Salvador Allende and Alfred Grotjahn are the key early contributors. Virchow is often named as the founder.
• The term "social medicine" became formalised around the 1920s; ibr gives 1920 as the birthdate of the discipline.
• In Bulgaria the department was founded in 1947, renamed Social Hygiene in 1964 and finalised as Social Medicine in 1984.
• After the Second World War, national health systems, preventive public health policies and community-based care grew.
• Social medicine is now interdisciplinary, drawing on sociology, economics, ethics, epidemiology and public policy.
• It shifted the focus from individual treatment to population health, and it produced tools such as health indicators, health economics and equity monitoring frameworks.

Social medicine is a scientific discipline that studies the social causes of health and disease. It is concerned with the relationship between medicine and public health. Accounts differ on its place: one describes it as a scientific branch of medicine focused on the social causes of health and disease, while another describes it as a specialisation within the field of sociology, with a focus on health and medicine. Both agree on what it studies.

Its scope, as sz sets it out, has two parts:

• social factors in aetiology (the cause of disease)
• the prevalence and interpretation of disease in society

ibr adds that social medicine helps us understand how social and economic factors affect health and disease. It also explains how the practice of medicine can help to implement social care and create the conditions that make society healthier.

The aims, in sz's words, are to improve health through prevention, education and public health policy, and to understand and reduce health inequalities.

ibr calls social medicine the theoretical base of public health services and health policy.

Social medicine emerged in 19th-century Europe. Two forces are named as the reason. The first was industrialisation. The second was poor living and working conditions. Social conditions were seen as the root causes of disease, so the remedy was sought in society as well as in the clinic.

The key contributors are set out in the table below.

Accounts differ in emphasis for Virchow and Grotjahn. One presents Virchow through his quotation and Grotjahn as a pioneer. Another presents Virchow as the attributed founder and Grotjahn as a pioneer and, among admirers, an inventor.

The term "social medicine" became formalised around the 1920s (sz). ibr gives 1920 as the birthdate of social medicine as a discipline, and says it is a young discipline.

Bulgaria is the second part of this history. Its department went through three names:

The timeline below shows the same sequence.

After the Second World War the field grew in three directions:

• the rise of national health systems
• the rise of preventive public health policies
• a greater focus on community-based care, on epidemiology and education, and on welfare-based medical systems

Social medicine therefore moved beyond the individual patient. It asked how whole populations were served by the health system.

Modern social medicine is an interdisciplinary field that combines five disciplines: sociology, economics, ethics, epidemiology and public policy. Each one contributes a different question. The table below shows how sz describes the three that most directly support public health.

The focus areas of the modern field are global health, access to care, structural inequalities and chronic diseases.

The main aims of social medicine are to:

• promote health equity
• understand and address social risks to health
• design and assess healthcare systems
• connect clinical care with population-level prevention

Its impact on medicine was a shift in focus. It moved from individual treatment to population health, and it incorporated preventive medicine and health promotion. It also developed tools that are still used:

• health indicators, such as morbidity and life expectancy
• health economics
• equity monitoring frameworks

Social medicine is defined in two ways: as a scientific branch of medicine, and as a specialisation within sociology. Both name health and social factors as its subject.

Q: Define social medicine in one sentence.

A scientific discipline that studies how social conditions affect health and aims to improve public health through prevention and policy.

Exam tip: Use the one-sentence definition above, then name prevention and policy as the two ways social medicine acts.

Q: How do epidemiology, sociology and statistics help public health?

Epidemiology studies patterns of disease in populations, sociology studies social behaviours that impact health, and statistics provides the data analysis tools. Together they show who gets sick, where, when and why, and they measure the trends.

Q: What are the rising challenges facing health systems?

• ageing populations
• rising costs, including increasing technology and equipment costs
• inequity in access
• the shift towards preventive care
• universal healthcare coverage goals (for example the UHC 2030 initiative)

Q: What is universal health coverage?

A system ensuring that all people can access needed health services without financial hardship.