Social Medicine What is social medicine Social science

社会医学 Social Medicine

What is social medicine? Social science l l l Sociology ECON Politics Anthropology Management Medicine Preclinical medicine l Clinical medicine l Preventive medicine l

What is medicine? 什么是医学 The science related to the diagnosis understanding prevention treatment of illness.

What is social medicine? 定义： 1. interactions and law between 是一门交叉学科，研究： the social factors and health & disease ; 2. stipulate social health strategy 1. 社会因素 健康和疾病 and measures; 3. Protect health & improve life quality, give the full display of 2. 制定社会卫生策略和措施 the social function of health, and upgrading the general health status of the people of 3. 保护和促进健康 the society.

Why we need to look at the social factors? Human being is more of the social creature than the animal. its social attribute is the fundamental nature New concept of Health by WHO 1948: Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. 人的本质属性(property)：在于其 社会属性 WHO：新的健康定义: WHO, 1948： 健康是： l 身体 l 心理 l 社会 的完好状态，而不仅是没有疾 病或身体虚弱而已。

人类的双重属性 The dual nature of human beings Aristotle : human beings are, by nature, social animals 社会属性 Social nature 生物属性 Biological nature Does it matter to health?

What’s Relationship between social factors and health? WHO put forward: Social determinants for Health l l l l Politics Economy Culture Environment Social security system Life style and behaviors Health care system l l l l 政治 经济 文化 环境 社会保障制度 生活方式和行为 卫生保健体制

Rudolf Virchow, German pathologist 1. Social and economic conditions profoundly impact health, disease and the practice of medicine. 2. The health of the population is a matter of social concern. 3. Society should promote health through both individual and social means. 1. 社会经济条件对健康、疾病和医 学实践具有深刻的影响； 2. 群体的健康应该成为社会关注的 内容; 3. 社会应该通过个人和社会的手段 来改善人群健康;

2、社会医学的研究内容 Contents of social medicine : l l l Social health status, mainly population health status; Influencing factors ; especially social factors Social health strategies and measures; （1）研究社会卫生状况，主要 是人群健康状况; （2）研究影响人群健康的因 素， 主要是社会因素; （3）研究社会卫生策略与 措施;

社会医学的核心内容 Core Contents l Diagnosis of social medicine--identify problems ---- 社会医学诊断 l Analysis of social cause of disease —social etiology ----- 社会病因分析 l Social medicine prescription social strategy ----- 社会医学处方

社会医学与临床医学的比较 l 社会医学：群体 social medicine: mainly target at population l 发现社会问题－－社会诊断 Identify social problem—social diagnosis l 社会医学分析－－了解社会成因 Social medical analysis—find out social causes l l 社会医学综合处方 Social comprehensive therapy l 临床医学：主要针对个体 Clinical medicine: mainly target at individual level l 了解个体健康问题－－医学诊断 Identify individual health problem---medical diagnosis l 开展病因学分析 Etiological analysis l 制定医学处方 Medial prescription

社会医学的性质 The Nature of Social Medicine l l ---Interdisciplinary subject—social science and medicine ---Synthetic research methods Practicality of social medicine l 医学和社会学的交叉学 科 l 采用综合的研究 方法 l 社会医学的实践性

3. 社会医学的任务 The tasks of social medicine Advocate positive concept of health, protect and increase physical and mental health and social activity capacity l l 倡导积极的健康观 l 改善社会卫生状况; 提 高人群健康水平和生命 质量; l 制定卫生政策和策略； l 开展特殊人群和特种疾 To improve social health status, enhance population health and quality of life formulate health policy &strategies carry out community health services and primary health care. To conduct preventive care services for special population and specific disease 病的预防保健 作;

4. Basic thinking of social medicine l l l Harmonious relationship between health and social development Two way interaction between health and social economic development 美国学者Mushkin。计 算出了美国在 1900— 1960年人口死亡率下 降带来的经济收益约 为 8200亿 l 协调发展的观念 l 双向作用的观念 人力资本 l 疾病对人力资本和劳 动生产率造成损失的 “ 3 D”框架 Death, Disability， Debility. 智力资本＋体力 资本

4. Basic thinking of social medicine l Positive concept of health—Bio-psychosocial medical model l 70％ 10% l 现代医学模式下的积极健 康观 70%健康人 USA 19000亿 20％慢病病人 1%最不健康

4. Basic thinking of social medicine Determinant role of social factors in prevention and treatment of diseases All sectors involvement in health works l 社会因素在疾病防治 中的重要作用 l 多部门参与 pharmaceuticals administration Personnel Financial 卫生 Population Education social insurance

社会医学发展史 The history of social medicine the embryonic stage of social medicine – development of social medicine in China – – 社会医学的萌芽 社会医学的创立和发 展 我国社会医学的发展

Embryonic stage-Hippocrates 希波克拉底 “Air, Water and Places”－－ environment, wind direction, sunlight water quality and citizen’s life style it is more important to know the person having the disease than to know the disease the -- person has； Hippocrates, born in 460 bc , father of modern medicine.

The role of Hippocrates on Modern Medicine l Hippocrates reject the notion that diseases have a supernatural cause. l 疾病的致病因素的研究－－推进的 医学的发展，否认疾病的产生是超 自然力量导致的； l l the first to perceive a relationship between cause l 以机械的眼光看待疾病的因果关系 and effect in a mechanistic way, providing the foundation for modern l 为现代医学的疾病因果理论奠定了 scientific notions of disease causation. 基础

“Humoural theory” The Hippocrates developed theory, as a physiological explanation of health and disease. all matter could be reduced to the basic elements earth, fire, air and water cold, hot, dry and wet; four humours of phlegm, blood, black bile and yellow bile. The elements, constituents and humours Health----mutual balance Disease---disorder

Pathogenesis of disease and the role of doctors The external influences of food and drink and climatic factors of excessive heat and cold influence internal mechanisms. l 饮食和环境因素—影响内在机制 l 医生的职责是恢复健康平衡; l The role of the physician was to restore the equilibrium of health. l 希波拉底的医学观是整体医学观 l The Humoural theory was a holistic one. l

Significance of Hippocrates l l l Before：mystical approach to disease characterized by the worship of gods, the fending off of evil demons Separate Western medicine from--a primarily mystical approach to disease. Marks the beginning of a rational *patho－physiology l 希波克拉底之前：疾病是由神 秘的超自然力量导致的； l 希波克拉底及其创立的学说将 西医与原始的神秘主义分割开 来 l 标志理性病理生理学的真正开 端

Embryonic stage of social medicine 1. Galen: ancient Doctor in Rome: focus on psychological factors upon health； 2. Peter Frank: German social hygienist: miserable life is the hotbed of diseases; “the National Supervision System”— supervision plan—government measures to protect public health l 古罗马医师盖伦：重视心理 因素对健康的影响; l 德国社会卫生学家: 弗兰克: 悲惨的生活是疾病的温床; l <全国医学监督体制>: 用医学监督计划使政府采 取措施保护公众的健康; 3. First person: social health measures to control disease l 提出社会卫生措施

社会医学的建立和发展 Establishment and development of Social Medicine l l l 1848 Frenchman Jules Guerin: first person–Social medicine Scattered medical supervision; public health and forensic medicine should be integrated into Social medicine: divided into 4 parts: Social physiology: Social pathology: Social hygiene Social therapeutics 法国医生儒勒. 盖林 l 第一次提出社会医学; l l 建议将分散的医学监督、公共 卫生、法医学构成一个整体： 社会医学---分为四个部分； 社会生理学； l 社会病理学； l 社会卫生学； l 社会治疗学。 l

德国病理学家 魏尔啸 German Pathologist: Rudolf Virchow l The kernel of medical science is social science l “Medicine is a social science l Politics is nothing more than medicine in broad sense l Best method of medicine is to combine medicine with social life and political activities l 医学科学的核心是社会科学 l 医学是一门社会科学；任何社 会都应对居民的健康负责； l 政治学是广义上的医学 l 实现医学目标的最好的办法是 将医学和社会生活和政治活动 结合起来

德国：格罗蒂杨 German A. Grotjahn theory of social pathology l 德国 格罗蒂杨: Book：social Pathology suggests ： disease should be studied from the standpoint of social view l Is a first person given lecture on social hygiene l 提出社会病理学的理论和 概念; l <社会病理学>用社会观点 研究人类疾病的原则 l 首次在柏林大学开设社会 卫生学讲座

Germany： Birthplace of social medicine l Before WWII l Social Hygiene l Social medicine l Later－－become social medicine l 德国是社会医学的发源地 l 二战前：使用社会卫生学 和社会医学 l 后改为社会医学

社会医学与其他相关学科的关系 The relationship of social medicine with other related subjects l preventive medicine l 预防医学 l community medicine l 社区医学 l medical sociology l 医学社会学 l health care management l 卫生管理学 l 医学心理学 l medical psychology

Preventive Medicine Preventive medicine studies how natural and social factors affect people’s health: How Disease occurred and spread put prevention fist Three-stage preventive measures focus on medical prevention Bio-preventive strategy mainly Social medicine grow out of preventive medicine

Social Medicine Vs Community Medicine l Community medicine l More practical l Operational l Both target at population level l Intermediate level l Enjoy same origin with social medicine l Offer guiding principle l Theory of social medicine be practiced in community medicine l l l The Practice of social medicine facilitate the development of theory of social medicine Social medicine l More theoretical l macro –mainly at policy level More theoretical, offer principle and guidance to CM l Offer methodology l

Medical Sociology l l l l Medical sociology belong to the disciplinary group of sociology concerned with social causes and consequences of health and illness social aspects of health and illness social functions of health organizations and institutions I healthcare systems vs. social systems social behavior of health workers and users patterns of health services 属于社会学的分支 l 关注健康和疾病的社会原因和 结果 l 从社会角度研究健康和疾病 l 研究卫生组织和机构的社会职 能 l 卫生系统和社会系统的关系 l 医生和患者的社会行为 l 利用卫生服务的格局 l

社会医学在各国的发展 Development of Social Medicine in different countries l l l In UK, course of social medicine is offered, social medicine research institute was established in Oxford University l 津大学成立社会医学研究院 l Professor John Ryle: all public health, industrial health, social health and medical care belong to social medicine In 1960 s, social medicine changed into community medicine 英国: 40 s 开设社会医学, 在牛 牛津大学: 赖尔教授: 公共卫生、 业卫生、社会卫生服务、公 共医疗事业都属于社会医学的 范畴 l 60 s社会医学改成社区医学

社会医学在美国的发展 In United States Medical sociology and family medicine developed l Emphasis on sociology, management and economics l Social medicine: was included in the course of health management and health policy l l 医学社会学和家庭医学得 到了发展； l 强调社会学、管理学和经 济学； l 社会医学包含在卫生管理 学和卫生政策学的讲座内 容中；

社会医学在中国的发展 Social medicine in China 50年代：《保健组织学》作为 医学生的必修课，成立保健组 织教研组 l 80年代：卫生部成立6所卫生管 理干部培训中心，社会医学成 为主干课程 l 90%以上的医学院开设了社会 医学课程 l l In 50 s, course of Health Care Organization is a compulsory course for medical student, research and teaching group set up in all medical college l In 80 s, Ministry of Health set up 6 training centers－－－ social medicine was the main course l 90% of medical college offered course in social medicine

参考文献： references l 李鲁主编：《社会医学》 第二版 l WHO ： 2002 world health report： Reducing risks，and Promoting Healthy Life Style WHO：social determinants of health； l World Bank：Macro l WBI： Getting Health economy and health； Reform Right。 World Bank 2002 l 龚幼龙主编：《社会医学 》第一版 l

Question: 思考题： why we should learn social medicine? What is the nature of this subject? what is social medicine？ why it is necessary and important for medical students ? the importance of studying it?