The concept of social medicine developed in the wake of the Industrial Revolution and its attendant social and health problems. Poor working conditions, periodic economic slumps, unemployment, lack of housing, and poverty and destitution all created an environment that had a significant impact upon people's health. Quantitative studies of mortality in England show that, for example, the average age of death in Liverpool in 1840 was 35 for gentry and professional persons and their families, 24 for tradesmen and their families, and 15 for laborers, mechanics, servants, and their families. In Manchester, the corresponding ages were 38, 20, and 17; and in Leeds they were 44, 27, and 19.
In France, Louis-René Villerme (1782–1863) studied mortality rates in the districts of Paris. 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.
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:
- The health of the people is a matter of direct social concern.
- Social and economic conditions have an important effect on health and disease, and these relations must be subjected to scientific investigation.
- Steps must be taken to promote health and to combat disease, and the measures involved in such action must be social as well as medical.
These basic concepts of social medicine were extensively developed in the first half of the twentieth century in continental Europe. After World War II, a strong movement for social medicine developed in the United Kingdom. In the United States, a broad concept of social medicine was developed by the economist and public health statistician Edgar Sydenstricker, the sociologist Bernhard J. Stern, the public health scientist C.E. A. Winslow, and the medical historian Henry E. Sigerist. However, the term was not adopted by American medical schools because of the conservative views of the medical profession.
On the other hand, the term "social medicine" is now in the process of being replaced because it is too limiting—the field encompasses a variety of professional disciplines other than medicine, and the term "public health" is becoming increasingly recognized as more accurate.
(SEE ALSO: Future of Public Health; History of Public Health; Social Determinants; Social Health; Virchow, Rudolf)
Bibliography
Chadwick, E. (1965). Report on the Sanitary Condition of the Labouring Population of Great Britain, 1842. Edinburgh: Edinburgh University Press.
Coleman, W. (1982). Death Is a Social Disease: Public Health and Political Economy in Early Industrial France. Madison: University of Wisconsin Press.
Rosen, G. (1947). "What is Social Medicine? A Genetic Analysis of the Concept." Bulletin of the History of Medicine 21:674–733.
Terris, M. (1957). "Concepts of Social Medicine." The Social Service Review 31:164–178.
—— (1985). "The Distinction between Public Health and Community/Social/Preventive Medicine." Journal of Public Health Policy 6:435–439.
— MILTON TERRIS
