EDITORIAL

Introducing Social Medicine The Editors

If a reader picked up a journal entitled By the end of the 19 th century pathology and Cardiology or Dermatology s/he would have a microbiology seemed to provide definitive answers fairly clear idea about the types of articles likely to to the questions of how and why people got sick. be found inside. It is less clear exactly what might Social explanations fell from favor. Since social be the content of a journal entitled Social Medicine . explanations raised politically “difficult” questions As a discipline, Social Medicine has many roots they were best left out of the education of a and many branches. Social Medicine has taken on profession that sought to create a monopoly on a variety of meanings as diverse schools of social health care. medicine (or its offspring community medicine) The resultant form of medicine, baptising itself have grown up in different parts of the world. “biomedicine”, proclaimed that it was grounded in What, then, is a reader to expect of this journal biology and highly scientific. Yet with time we Social Medicine ? have grown to appreciate that the program of biomedicine is quite restricted. We can, for The nature of Social Medicine instance, understand in great molecular detail the Despite the diversity in its expression certain hows and whys of the HIV virus. This fundamental ideas lie behind the concept of social understanding does little to explain the patterns of medicine. The most important is that the structure spread of the virus. More importantly, although we of a society profoundly influences who will be may develop the technical means to treat the virus healthy and who will be well. Societies have (and hopefully the vaccine to prevent it), certain characteristic patterns of illness and microbiology and pathology have not told us how particular – often radically divergent – conceptions to deliver those interventions to the people that of what constitutes health. How we go about caring need them the most. Can we hope to combat the for human suffering responds to social as well as pandemic of Type II diabetes without consciously biological imperatives. In short, the biological understanding – and critiquing - the political reality of human existence is inextricably a social economy of agriculture in the modern world? A matter. medicine that is not consciously social is a giant As an academic discipline – rather than an with feet of clay. intuitive understanding – these ideas can be traced Modern biomedicine considers itself imper- to European physicians of the period around the vious to social considerations and concerned only . At that time statistical data with hard biology. In doing so, it only highlights became increasingly available for the large towns the degree to which it is unconscious of the very of Europe and it was possible to demonstrate in forces that move it along. When Abraham Flexner statistical ways what was visible to the untutored revolutionized the teaching of medicine in the eye: the poor and working class lived short, United States one of the results was a sharp unhealthy lives compared to those of the wealthy. restriction on the access of women and blacks to the Physicians were well aware that the social profession. This can hardly have responded to any conditions of the working class were central to the imperatives of biological science. Yet this was a production of disease and many used this decision that continues to profoundly impact the knowledge to critique the political and social character of medical practice today. A socially conditions of early capitalism. neutral biomedicine is, quite simply, a nursery tale.

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It is our hope that this journal may serve as a the international division of labor, called for the catalyst to revitalize the discussion within the house expansion of primary care and set the goal of health of medicine concerning the role and importance of for all by the year 2000. Animating this vision social factors. The care of individual patients can- were the ideas that health is an intrinsic good, that not occur in the absence of a conscious appreciation access to health care should be a fundamental of the social context. human right and that the responsibility for the promotion and preservation of health lies not only with the individual, but also with the State. The Physician as the Natural Advocate for the Nothing could be farther removed from the Poor realities of the global that is currently In this first issue we publish ’s emerging. While every country is different, yet in 1848 report on the Silesian typhus , a each the plan is the same. Health is seen, not as a cornerstone document in social medicine. In the public good or a human right, but as a tool to conclusion of his report, Virchow writes: produce healthy workforces (i.e. as a support for “Medicine has imperceptibly led us into the social economic development) or as a commodity to be field and placed us in a position of confronting bought and sold. We are told that the rational directly the great problems of our time.” distribution of health resources will occur only in a We intend that Social Medicine stand firmly in more or less regulated marketplace. This is a this rich interface between clinical care and social position that has no basis in any historical criticism. There is a reason that, again quoting experience. And so the public financing of Virchow, physicians are the natural advocates for healthcare is increasingly challenged or funneled the poor. The daily work of most clinicians into private corporations. Health care becomes a involves interacting with the lives of people who commodity, patients become customers, clinical are not rich and powerful. Malnourishment, lack of services are product lines. It is only rational, health care, poor living and working conditions, therefore, that academic medicine and medical substance abuse, violence – the social problems of research become handmaidens to big Pharma. the contemporary world walk into the clinician’s Since it is obvious – even to the most extreme office every day. The mundane details of the social ideologues - that the market will not solve the determinants of health are writ small in our daily health problems of the poor, we now have a series encounters with patients. of stripped-down, on-the-cheap health programs for In concrete terms what does it mean to be a them, currently embodied in the Millennium natural advocate for the poor in the early 21 st Development Goals. Only the most limited, cost- century? The broad social context for the effective, “evidence-based” interventions will be emergence of social medicine lay in the Industrial funded. Instead of primary care and a vibrant Revolution. The broad social context in which system the poor get a global fund for health and health care is evolving today is that of AIDS, Tuberculosis and Malaria. The grand goal increasing globalization within the context of of Health for All by 2000 has been consigned to the modern imperialism. This context confronts us dustbin of history. This is the well-funded, well- with widely divergent views on the meaning of heeled and well-promoted ideology of corporate health and the role of health care. and imperialist healthcare in the 21 st century. The World Health Organization, formed in the Sadly, the many lessons of social medicine have aftermath of the Second World War, enunciated a been forgotten. AIDS, tuberculosis and malaria are broad and holistic view of heath as a state of well- all diseases embedded in a social context. They being. This was a vision later expanded in the will not be eradicated without addressing that WHO’s 1978 Alma Ata declaration which critiqued context. The difficulties in fully funding the Global

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Fund and the Millennium Development Goals The rich historical experience of Latin simply underscore the global social realities which American Social Medicine allows a certain have allowed these diseases to flourish. optimism at this beginning of the 21st Century. What does it mean to the “natural advocate for There are diverse national schools throughout the the poor in 2006? It means to promote the vision of region and a cadre of practitioners with extensive holistic health that is made available to all. political and technical experience. The poverty and polarization that exist throughout the The distinctive role of Latin American Social Continent, reminiscent in many ways of the Medicine conditions of the early Industrial Revolution, force Latin America has seen the development of a any theoretical discussion to remain firmly planted distinctive school of social medicine that has in the regional reality. managed to be both an active participant in the This Latin American tradition has been political arena and to maintain a high degree of relatively unknown within the English speaking critical and autonomous thought. The model world. One of the goals of this journal is to break espoused by Latin American Social Medicine is down that linguistic blockade and begin a captured in Débora Tajer’s analysis of the ways in discussion between Latin American Social which Social Medicine differs from traditional Medicine and the English-speaking world. clinical medicine and public health:1 What principles guide this journal? 1. Social Medicine studies populations as 1. Social Medicine has a rich historical legacy, collective groups and not simply as an much of which has been lost or suppressed. assortment of isolated individuals. The current debates on health inequalities and 2. Social Medicine examines the internal logic equity have been prefigured in some of the and social role of health institutions. If health early work in social medicine. We can turn to care institutions have the capacity to reinforce this literature for inspiration and edification. existing social relations of domination, they can 2. Any discussion of health is inevitably an also to develop alternatives to those relations. international discussion. Our journal addresses 3. Social Medicine looks at health and disease in a a global audience and seeks to further an dialectical manner. Health care does not exist international conversation. Thus, we will in isolation. It is part of a historical process. publish initially in both English and Spanish, 4. Social Medicine emphasizes that social and hoping to add additional languages with time. historical processes are determinants of the 3. Academic publishing has largely been in the relationship between health, disease and health hands of the developed countries. We care both for individuals and social groups. recognize this and will organize the journal in 5. Praxis, the interweaving of theory and political such a way as to be as welcoming as possible activism, allows for theoretical approaches to for authors and readers from a variety of health that do not merely describe reality but countries. also promote social change. 4. We will seek to publish material that is ignored 6. Social Medicine seeks to develop a or unwelcome elsewhere. The 2005 meeting of methodology that enriches both quantitative the People’s Health Assembly went almost and qualitative research with historical without comment in the world press and perspectives. In doing so it tries to overcome particularly the medical press (the British the limitations of the positivistic and Medical Journal and PLoS were notable excep- reductionist approaches common to both tions). We will strive to make sure that voices traditional clinical medicine and public health.

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like that of the PHA are given more We intend to use the peer-review system not international attention. only as a means of assuring scientific quality, but 5. The journal will seek to promote activism and also – when appropriate - as means of mentoring political organization in support of the WHO authors. Authors from the non-English speaking Alma Ata goals of Health for All and the world face a number of hurdles in seeing their work holistic vision of health contained in the WHO published in the international medical literature. charter. This will require a civil mobilization We intend to offer those authors whose papers we for the recognization of a right to health as a think have merit, the opportunity to work with a fundamental human right and for universal peer reviewer/mentor to improve the quality of their public systems of health care. work. It is our hope that this system will open the 6. The journal will produce materials that are medical literature to articles that would otherwise scientifically sound, intellectually honest, free not get published. of commercial biases, clearly written and well Initially the journal will publish with six presented. Access to the journal will remain sections and an editorial column. Additional free for both authors and readers. sections may be added with time. Authors are welcome to submit work to the following sections. What are our plans for the journal? Social Medicine will be published on a 1. Original Research quarterly basis. It will be published initially in 2. Classics in Social Medicine English and a mirror version in Spanish will be 3. Case Studies in Health Activism available in the next few months. By the end of the 4. Social Medicine in Practice year simultaneous English and Spanish journals 5. Social Medicine Black Bag will come out in January, April, July and October. 6. News & Events We will function in many ways as a traditional academic journal, following the codes of the Authors should consult our website for detailed ICMJE, using a system of rigorous peer review and information regarding submissions to these focusing on scientific papers. However, there will sections. Authors should understand that their be a number of important differences in the way our work will be translated into both English and journal functions. We will not accept advertising or Spanish and published in both the English and funding from drug companies. Thanks to the Spanish Journals. For more specific information, availability of free journal software from the Open please consult our website. Journal Systems we can operate on a relatively small budget. We do not intend to charge authors Welcome to our journal. or readers and we will not accept advertising. All the editors work as volunteers. We do have The Editors significant translating and copy-editing expenses and will gladly accept donations. We will adhere to References the Commons Copyright agreement that allows 1. Tajer D. Latin American social medicine: roots, non-commercial reproduction of our papers with development during the 1990s, and current attribution except where otherwise indicated. We challenges. Am J Public Health 2003; 93(12):2023- are hoping to use some of the special features of an 2027. on-line journal such as the ability of post video and audio feeds.

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