Social medicine Intro History Assistant Professor Ozren Polašek

Social medicine Intro. History Assistant Professor Ozren Polašek Department of Public Health and Croatian Centre for Global Health

Course outline • • • Social medicine Timetable Seminars (guided and student) Exam (B 3 and B 4; 9. 40, FRI 19. 10. ) Absence?

Social medicine / Public health Izvor fotografija: http: //www. biojobblog. com/, http: //meded. ucsd. edu/clinicalmed/, http: //www. pw. org

Izvor slike: http: //www. isrswimkids. com/register. html

Needs of the few vs. needs of the many? • Is it better to do a lot for the few [liver transplant to a chronic alcoholic, ~400. 000 Kn] or a little for a lot [hepatits B vaccination a 280 Kn for 1429 kids]? Izvor slike: http: //www. safa. tv Izvor slike: http: //www. askamum. co. uk/

R. Virchow Die Medicinische Reform, 1848 Izvor fotografije: http: //sinapsis. usach. cl/moodle/

Virchow’s ideas • He advocated that medicine be reformed on the basis of these principles: – the health of the people is a matter of direct social concern – social and economic conditions have an important effect on health and disease – the measures to promote health and combat disease must be social as well as medical (The Medical Reform, 1848)

Virchow’s career • Suspended from Berlin Medical school • Pathology chair in Wurzberg • Returned to Berlin in 1856, elected to City Council in 1861, and German Reichstag in 1880 • Refused to be knighted as “von” Virchow • Accused of being “unpatriotic” (met with the French)

Medicine is a social science, and politics is nothing but medicine in the large scale R. Virchow Die Medicinische Reform, 1848 Izvor fotografije: http: //sinapsis. usach. cl/moodle/

Izvor slika: www. google. com tražilica/preglednik

History of social medicine §JP Frank (1786): hygiene and social medicine, Medizinische Polizei §J Guerin (1848): term social medicine §England (1848): Law on public health §England (1856): First course in public health Izvor slike: http: //www. trading-house. net

Historical development § Semaško (SSSR): Health care organization § Grotjan (1915): social pathology (alcoholsm, tubeculosis, veneral diseases) § 1923. CEA Winslow: Public health definition

Izvor slike: www. dubrovacki. hr

Croatian contribution? • 1776. - Lalangue: first medical book in Croatian • 1807. Proclamation on the mandatory chickenpox vaccination in Dalmatia (1789. E. Jenner) • 1830. K. Peičić: poor people’s insurance • 1833. Miners guild in Samobor requires health insurance • 1873. Worker’s society for help in need founded in Zagreb • 1891. Patients insurance founded in Croatia and Slavonia • 1893. Zagreb - “Royal state institute for manufacturing animal vaccination againts chickenpox” • Andrija Štampar (1888 -1958)

Izvor fotografije: http: //www. croatia. org Founding Committee of the World Health Organization

1926. Andrija Štampar: 10 health commandments • Informing the people is more important that the law • The most important thing is to lay the groundworks for understanding of the health issues in any region • Question of the people’s health and its improvement is not a monopoly of the physician, it should include everybody. Only through joint cooperation and synergy ill it be possible to improve the health of the entire population

• Physician needs to be a social worker; indivdual therapy does not go very far; social therapy can bring in much more improvement • Physician must not be economically dependent on the patient • In matters of people’s health there must be no difference between the rich and the poor • We need to develop an institution in which physician will seek for the patient, and not the other way round, for only this can provide better health for more people

• Physician must be a people’s teacher • Question of the people’s health is of greater economical than humanitarian meaning • Main physicians workplace should be settlement and places where people live, not laboratories and clinics

Izvor fotografije: http: //www. magicus. info

Social medicine context • Several chapters which define the general direction of social medicine • Alma Ata Declaration • Ottawa • Jakarta • Health for All

Why do we need Social medicine? • 3 billion people live on less than $2/day. • 2. 6 billion without access to adequate sanitation • 2 billion deprived of electricity • 1 billion without adequate shelter • 840 million malnourished • 880 million without access to medical care 1998 Human Development Report, UN Development Program

Wealth distribution • The 200 richest people in the world more than doubled their net worth in the four years prior to 1998, to $1 trillion. • The wealth of the richest 225 people in the world is greater than the collective wealth of 2. 5 billion people (47% of the world’s population). • The 15 richest have assets that exceed the total GDP of Sub-Saharan Africa.

Ten essential services • Assessment – Monitor health status to identify community health problems – Diagnose and investigate health problems and health hazards in the community – Evaluate effectiveness, accessibility, and quality of personal and population-based health services

Ten essential services • Policy development – Develop policies and plans that support individual and community health efforts – Enforce laws and regulations that protect health and ensure safety – Research for new insights and innovative solutions to health problems

Ten essential services • Assurance – Mobilize community partnerships to identify and solve health problems – Link people to needed personal health services and assure the provision of health care when otherwise unavailable – Assure a competent public health and personal health care workforce – Inform, educate, and empower people about health issues.

Social medicine targets 1. 2. 3. 4. 5. Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from coronary heart disease and stroke 6. Safer and healthier foods 7. Healthier mothers and babies 8. Family planning 9. Fluoridation of drinking water 10. Recognition of tobacco use as a health hazard

Medical sociology • Medical sociology (sociology of health & illness) is concerned with all those aspects of contemporary social life which impinge upon well-being throughout the life-course.

Social medicine • • • Social medicine Public health and organisation of the health care Epidemiology School medicine Microbiology Health economics Preventive medicine* Medical sociology …

Conclusion • Focus on the population • a little for a lot http: //www. pw. org

Next 23 minutes… • http: //www. youtube. com/watch? v=8 ms 8 emc o. WZM