Social Medicine History and Contemporary Relevance

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Outline. Segments of social medicineHistoryContemporary examplesAdvocacy and social equity. Segments. Therapeutic carePreventive medicinePublic healthSocial prosperity. Result. Guarantee all inclusive and fair access to and fitting utilization of a powerful and productive therapeutic consideration systemEncourage preventive medicineStrengthen administrative wellbeing authoritiesIncrease assets for the advancement

Presentation Transcript

Slide 1

Social Medicine – History and Contemporary Relevance Social Medicine, Human Rights, and the Physician Emory Medicine, 2 nd year elective Timothy H. Holtz, MD, MPH Alyssa Finlay, MD January 10, 2005

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Summary Components of social solution History Contemporary cases Advocacy and social equity

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Components Medical care Preventive medication Public wellbeing Social prosperity

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Consequence Ensure all inclusive and impartial access to and suitable utilization of a powerful and effective therapeutic care framework Encourage preventive drug Strengthen legislative wellbeing experts Increase assets for the advancement of social prosperity

Slide 5

Recognition Medical experts ought to perceive a patient as a social animal, that numerous parts of their lives affect upon their wellbeing, their introduction to sickness and ailment creating practices, and their "organization" (ability to assemble assets to enhance prosperity)

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Consequence A socially-arranged doctor would make a move to enhance lodging, nourishment, instructive open doors, and business openings; battle prejudice and segregation; wipe out destitution; and modify the disparities and deficiencies of the restorative care conveyance framework… and in the public arena everywhere

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Change pathogenic circumstances in the group to secure group everywhere May bring about social and expert insult (scorn/disfavor) May confront resistance in utilizing your expert part to improve pathogenic social circumstances Ibsen's Dr. Stockman = Enemy of the People

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Ethics and obligation Modern prescription ought to incorporate extended ideas of the doctor's duty to society Physicians ought to think about the worldwide powers that cause or add to ailment or keep its enhancement Physicians can receive a backing part in seeking after change that will net outcome in wellbeing upgrades (great degree)

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Contemporary Social Medicine Galdston – British scholar Rosen – history specialist Silver – therapeutic antiquarian Terris – diary editorial manager, Vermont Navarro – general wellbeing at Hopkins Roemer – general wellbeing at UCLA Eisenberg – Harvard Dept of Social Medicine Sidel – emeritus educator, Einstein Dept S Waitzkin – anthropologist, Univ NM Farmer – Harvard Dept of Social Medicine

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"An Introduction to Social Medicine" Tom McKeown and CR Lowe, Welsh National Medical School Social Medicine is worried with an assemblage of learning and techniques for getting information proper to a teach. This train might be said to bargain: Epidemiology The investigation of the restorative needs of society (therapeutic care)

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Important figures in Social Medicine France – Cabanis, Villerme, Guepin ["Illness is dictated by the mistakes of society" 1804] England – Thackrah, Chadwik, Engels [ Inquiry into the Sanitary Condition of the Laboring Population of Great Britain , 1842] Germany – Virchow, Neumann, Leubuscher Chile - Salvador Allende

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Friedrich Engels (1820-1895) Called thoughtfulness regarding the soundness of the regular workers

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Engels Family possessed a processing plant in mechanical England, mid 1800s Held solid perspectives against Puritanism Active in news coverage at a youthful age, depicted laborer's ailment and enduring with an enthusiasm "Hung out" with Irish progressives

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Condition of the Working Class in England, 1845 First genuine record of the medical issues of working kids and grown-ups Roots of ailment and early demise lay in the association of generation and the social condition Industrialism constrained common laborers individuals to live and work in conditions that definitely created disorder Clear examination of the causal relationship between social structure and physical sickness

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Issues secured by Engels Environmental poisons, lead harming Infectious ailments, for example, TB, typhus Nutrition and nourishment supply Alcoholism Maldistribution of medicinal faculty Mortality rates and social class Industrial mischances Occupational ailments of the musculoskeletal framework, eye, lung

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Rudolf Ludwig Karl Virchow (1821-1902) the "Father" of Social Medicine

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Virchow's vocation A pathologist and restorative school speaker in Berlin Pioneer in building up cell principle in pathology and impacts of illness in the human body He authored the terms thrombus and embolus, leukocytosis and leukemia, amyloid and heme shades, "Virchow's hub" Discovered the pathophysiology of trichinosis, called for mandatory meat review in Germany Designed and directed Berlin sewage framework Never acknowledged the straightforward causal relationship amongst bacterium and malady (Koch)

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Die Medicinische Reform, 1848 Founded/altered the restorative week after week with Rudolf Leubuscher, kept going just 48 issues Analyzed social structure of society and now it identified with the spread of ailment Used diary as a stage to call for enhancements in lodging and sustenance, business and salary

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Typhus plague in Upper Silesia Epidemic of backsliding fever among coal excavators and their families in Prussian area of Upper Silesia in Feb/March 1848 Tradition to send a lesser instructor to research the issue, compose a report, and hold it Virchow burned through 3 weeks in mid 1848 exploring the Polish families and their conditions in Silesia Virchow's discoveries and report earned him reputation as a dynamic pioneer in Germany, brought forth the social prescription development, and adjusted the direction of his profession

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"The doctor is the characteristic lawyer (advocate) for poor people."

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Report on the Typhus Epidemic in Upper Silesia, 1848 Geographical, humanities, and social record of Silesia Description of lodging, training, abstain from food, drinking, restorative convictions Analysis of the part of the Catholic church, and propagation of rank like social stratification Detailed clinical record of typhus, nine case portrayals, five post-mortem reports Assesses legitimacy and precision of accessible wellbeing measurements of typhus Analyzes horribleness and mortality of typhus by age, sex, occupation, social class

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Conclusions of Report on the Typhus Epidemic in Upper Silesia, 1848 Virchow announced that the fundamental reasons for the scourge were more social than medicinal Economic and political conditions in Upper Silesia assumed a critical part The conditions in which the specialists were compelled to live, especially terrible lodging with hunger, that made them defenseless against ailment

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"Progressive thoughts" Public arrangement of medicinal tend to the needy, including free decision of doctor Prohibition of youngster work Protection for pregnant ladies Reduction of work hours in unsafe occupations Control of dangerous substances at work Adequate ventilation at work destinations

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Quotes "There can't be any uncertainty that such a typhus pandemic was just conceivable under these conditions and that at last they were the aftereffect of the destitution and a work in progress of Upper Silesia. I am persuaded that on the off chance that you changed these conditions, the pandemic would not repeat. In principle, the response to the question concerning how to avoid episodes in Upper Silesia is very basic: instruction, together with its little girls, opportunity and welfare."

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"With one and a half million you can't start with palliatives, on the off chance that you need to accomplish anything you must be radical." "The undertaking of any sensible and law based government will dependably be to teach the general population and free them, substantially as well as profoundly." "The outright detachment of school and church is more vital in Upper Silesia than anyplace." "That is the reason I demand that free and boundless popular government is the absolute most vital guideline. In the event that we get free and knowledgeable individuals then we should without a doubt have solid ones too."

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Section on long haul arranging Unlimited vote based system Devolution of basic leadership Universal training Disestablishment of the congregation Taxation change Agricultural change Industrial advancement

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Virchow and the introduction of Social Medicine He pushed that medication be transformed on the premise of four standards: That the wellbeing of the general population involves coordinate social worry That social and financial conditions importantly affect wellbeing and malady and that these relations must be subjected to logical examination That the measures take to elevate wellbeing and to battle ailment must be social and in addition therapeutic (Th e Medical Reform, 1848 )

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Virchow's political vocation Suspended from Berlin restorative school Pathology seat in Wurzberg where he composed his great pathology writings Returned as Chair of Pathology in Berlin in 1856 Elected to Berlin City Council in 1861, and German Reichstag in 1880 Questioned increments in military spending plan while instruction spending plan stagnated Accused of being "unpatriotic" (met with the French) Refused to be knighted as "von" Virchow

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Accomplishments City sewage frameworks in Berlin and different urban communities Mandatory meat investigation Ventilation and warming of open structures School wellbeing administrations Improvement of working states of wellbeing faculty, esp attendants

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Virchow's counterparts Max von Pettenkoffer – tenacious imperviousness to the hypotheses of Pasteur and Koch that bacterium was fundamental and adequate Alfred Grotjahn – safeguarded emphasis on social variables other than cleanliness from forming into exclusively a development for sterile change, as it had in UK Social Medicine spread all through mainland Europe in late 1880s, social pharmaceutical consolidated into therapeutic instruction and practice in Czechoslovakia, USSR, France, Belgium

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Grotjahn's Social Pathology, 1911 The noteworthiness of a sickness is dictated by the recurrence in which it happens. Medicinal measurements are along these lines the reason for any investigat

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