Social Medicine: we need a 300 year plan

The WHO defines health as follows: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

I like this definition for including the phrase "social well-being".


When we talk about “lifestyle” and lifestyle changes that need to happen to prevent chronic disease, we are talking about what is really a social problem.

Social medicine is the field that is concerned with building the infrastructure we need for healthy communities. 

Our default when we think about health is to think of it as a biological phenomenon, lying within one individual.  While I wouldn’t argue that this is not the mechanism through which disease seems to be expressed, I would argue that this does not accurately reflect the whole picture.


Take the following pieces of trivia:

1)   Childhood trauma predicts poor physical and mental health in adults, and chronic pain (Goodwin & Stein, 2004; Van Houdenhove & Luyten, 2006). 

2)   Low SES or social trauma (Benjet, 2010) in childhood also predicts chronic disease in adulthood (Pollitt et al., 2005).

I found this so surprising when I first came across it.  SES matters to the development of chronic disease.  Why should that be?! What does that mean?  Well, my take homes were this:

1)   The psychological and the physiological aspects of health are intertwined in complex ways.  Maybe negative social pressures are the reason motivational interventions in chronic disease often fail: those who had the mental & social resources to implement positive change already have! (And hence did not develop chronic disease in the first place.)

2)   Health and behavior are community (see: family systems) issues.

Public health policy has been most involved in the field of social medicine so far.  Interventions range from sex ed to food regulation.  This work is invaluable, but we need more. We know that we need to eat right, exercise, not be too stressed, not get too fat... We know what we need to do, but still, we don't seem to have the the infrastructure in place to make it easy, or natural, to do those things.  Healthy food is harder to access than unhealthy food.  Pollution is a growing problem.  And a cursory look at the news shows that social strain, conflict, and stress are poorly managed among many of us.  

Part of the problem is just life.  The other part of the problem is just bad (social) planning.  



Social medicine asks what we are doing to promote:

-     Public health policy that benefits both individuals and communities

-     Community & health development

-     Individual care (combining the best of both physical and psychological treatments)

-     A systems approach that takes into account the social value of healthcare (i.e., what, other than direct medical care, does a patient get out of a hospital or clinic visit?  Social support?  Empathy?  If so, how best can we design our health care system and other aspects of social infrastructure to provide its members with support sustainably throughout a lifetime?)   

 
With the problems the world is facing today in terms of sustainability, wars, pollution, etc… we need interventions that not only help us right now, but help us long term.  Forget a 30-year plan, we need a 300-year plan.
  
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 On social medicine and its uses:

- The Canadian Facts  
- WHO Social Determinants of Health 
- Monthly Review 
- Wikipedia (always)