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Essay How Did Social Medicine Evolve, and Where Is It Heading? Dorothy Porter Introduction The academic discipline of social medicine has struggled to fi nd a precise definition for over a century. This struggle is exemplified by the classic social medicine course book, The Social Medicine Reader, edited by faculty from the Department of Social Medicine at the University of North Carolina, Chapel Hill, which offers an expansive view of social medicine’s concerns [1–4]. These concerns range from early visions of the discipline, focusing on topics such as the social and economic structure of health-care provision, health policy, and clinical holism, through to evolving concepts of the field, such as concerns with doctor/patient relations in culturally diverse societies. The evolution of social medicine as an academic subject has been internationally diverse and a coherent definition of the discipline has remained elusive. In this essay, I briefly examine some of the diverse developments of social medicine as an academic discipline and its links to political conceptualizations of the role of medicine in society. I then analyze the possible future directions open to the discipline in the Anglo-American context. A better understanding of the evolution of social medicine could help to focus its role in responding to the health needs of a post-industrial, globalizing world. The Essay section contains opinion pieces on topics of broad interest to a general medical audience. The Interwar Years of the Twentieth Century: Programs of Social Reform In 1945 René Sand was appointed as Professor of Social Medicine at Brussels University, one of the fi rst professors appointed in this discipline. His post had been created by a fi nancial endowment from the Rockefeller Fund. Sand believed that the roots of social medicine lay in ancient Greek philosophies of medicine and health [5]. Sand’s younger contemporary, George Rosen, a historian and Professor of Public Health at Yale, traced the origin of the modern concept of the social role of medicine to the nineteenth century. Rosen emphasized the role of French and German health and social reformers, including Jules Guerin, Alfred Grotjahn, and, above all, Rudolph Virchow, the liberal politician and founder of cellular pathology [6,7]. Nineteenth-century health and social reformers had been concerned with developing the political role of medicine in creating egalitarian societies [8]. This concern continued to be a primary goal of twentieth-century medical academics, such as Sand, who wanted to integrate medicine’s social role into the training of physicians through the creation of a new academic discipline of social medicine [9]. Virchow had articulated the need to develop a sociological method of inquiry into the conditions that maximized health and prevented disease [8]. Inspired by the experiments in sociological medicine and social hygiene in revolutionary Soviet society in the 1920s, interwar sociomedical reformers on both sides of the Atlantic believed that the creation of a sociopolitical role for medicine could be achieved by turning it into a social science [9]. The interwar years witnessed a wide variety of international developments in social medicine as an academic discipline. At Yale University, the DOI: 10.1371/journal.pmed.0030399.g001 A march in support of Salvador Allende, who influenced the development of Latin American social medicine (Photo: US Library of Congress) Institute of Human Relations was created in 1931 under the direction of Milton Winternitz, the dean of the Medical School. The aim of the institute was to integrate medicine into research on social inequalities, which would inform the training of physicians to become, in Winternitz’s words, “clinical sociologists” [10,11]. In the 20s and 30s Sand played a critical role in the international promotion of the new academic discipline of social medicine, especially in Latin America, where his work for the Rockefeller International Health Funding: The author received no specific funding for this article. Competing Interests: The author has declared that no competing interests exist. Citation: Porter D (2006) How did social medicine evolve, and where is it heading? PLoS Med 3(10): e399. DOI: 10.1371/journal.pmed.0030399 DOI: 10.1371/journal.pmed.0030399 Copyright: © 2006 Dorothy Porter. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abbreviations: LASM; Latin American social medicine Dorothy Porter is Professor in the History of Health Sciences and Chair of the Department of Anthropology, History and Social Medicine, University of California San Francisco, San Francisco, California, United States of America. E-mail: porterd@ PLoS Medicine | www.plosmedicine.org 1667October 2006 | Volume 3 | Issue 10 | e399Board supported the creation of social medicine institutes and departments at the University of San Marcos in Lima, Peru and the Oswaldo Cruz Institute of Rio de Janeiro in Brazil [12,13]. At the University of Chile, Max Westenhofer, a former Virchow student, taught social medicine as well as pathology to the future president of Chile, Salvador Allende. Allende developed a Marxist conceptualization which profoundly influenced the subsequent development of Latin American social medicine (LASM) and which was reflected in the creation of a national health service under his presidency in the 1970s [14]. Within international health organizations in the interwar years, supporters of social medicine as an academic discipline tried to undermine any exclusive focus on clinical medicine and pushed towards much broader social agendas. From the time of its establishment, the governing committee of the League of Nations Health Organization prioritized the development of social medicine. The International Labor Organization’s representatives on the committee persistently argued that issues of social medicine could not be separated from the question of access to services that fundamentally affected the health of workers [15]. Before the Second World War, the International Health Committee of the Rockefeller Foundation also identifi ed social insurance as a central issue of policy promotion. As Paul Weindling has pointed out, the


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MIT HST 934J - How Did Social Medicine Evolve, and Where Is It Heading?

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