SOCIAL MEDICINE Edited by MICHAELA KOSTIČOVÁ First Edition Comenius University in Bratislava Slovakia 2015 Moderné vzdelávanie pre vedomostnú spoločnosť/Projekt je spolufinancovaný zo zdrojov EÚ KOSTIČOVÁ, M. (ED.) SOCIAL MEDICINE First Edition Comenius University in Bratislava, Slovakia, 2015, 181 pages. © Michaela Kostičová, MD, PhD, MPH Silvia Capíková, LLM et MA, PhD Leonard Levy, DPM, MPH Cecilia Rokusek, EdD, MSc, RD Darina Sedláková, MD, MPH Anthony Silvagni, DO, PharmD, MSc, FACOFP, FAFPE Assoc. prof. Ivan Solovič, MD, PhD 2015 Reviewers Prof. Jan Holčík, MD, DrSc Prof. Jozef Matulník, MA, PhD Proofreaders Mgr. Martin Gazdík ISBN 978-80-223-3935-3 Printed by KO& KA in Bratislava 2015 This textbook was prepared and published within the project “MPH curriculum development at Comenius University in Bratislava in English language”, ITMS code: 26140230009, funded by European Social Fund - Operational Programme Education (ESF – OPE). Recipient of the ESF: Comenius University in Bratislava, Faculty of Medicine. Head of the project: Prof. Ľudmila Ševčíková, MD, PhD This textbook is from the series of textbooks listed below. The aim of the textbooks, funded by ESF-OPE, is to provide students of the study program Master of Public Health (MPH) at Comenius University in Bratislava with information and knowledge of public health issues. Biology and Genetics for Public Health, Pharmacology in Public Health Basics of Clinical Microbiology and Immunology for MPH Students Environmental Health - Hygiene Occupational Health and Toxicology Epidemiology for Study of Public Health Vol.1. Epidemiology for Study of Public Health Vol.2. Introductory Biostatistics Social Medicine Health Promotion andHealth Communication Public Health Ethics - Selected Issues An Introduction to Public Health Law Healthcare Management Information Technologies in Medicine, Medical Information Systems and eHealth Management of Information Systems Projects in Transition to Knowledge Management Authors Silvia Capíková, LLM et MA, PhD Institute of Social Medicine and Medical Ethics Faculty of Medicine in Bratislava, Comenius University in Bratislava Michaela Kostičová, MD, PhD, MPH Institute of Social Medicine and Medical Ethics, Faculty of Medicine in Bratislava, Comenius University in Bratislava Leonard Levy, DPM, MPH Nova Southeastern University, College of Ostophatic Medicine, Florida, USA Cecilia Rokusek, EdD, MSc, RD Nova Southeastern University, College of Ostophatic Medicine, Florida, USA Darina Sedláková, MD, MPH Head of World Health Organization Country Office in the Slovak Republic Anthony Silvagni, DO, PharmD, MSc, FACOFP, FAFPE Nova Southeastern University, College of Ostophatic Medicine, Florida, USA Assoc. prof. Ivan Solovič, MD, PhD National Institute for TB, Lung Diseases and Thoracic Surgery Vysne Hagy Faculty of Health Care, The Catholic University in Ruzomberok CONTENTS Preface . 9 1 INTRODUCTION TO SOCIAL MEDICINE (Michaela Kostičová) . 10 1.1 What is Social Medicine?. 10 1.2 History of Social Medicine. 11 1.3 Health and disease. 13 1.3.1 Health and disease concepts . 14 1.3.2 Determinants of health and disease . 17 1.3.3 Classification of diseases . 19 1.3.4 Health and quality of life . 20 2 SOCIOLOGY (Silvia Capíková) . 24 2.1. The nature and object of sociology . 24 2.1.1 Paradigm and theory in sociology . 25 2.1.2 Structure of sociology . 26 2.2. Sociological research . 27 2.2.1 Basic steps in sociological research . 27 2.2.2 Research methods in sociology . 28 2.3. Sociology of health and illness or medical sociology? . 29 2.4. Social groups . 29 2.4.1 Types of social groups. 30 2.5. Community. 31 2.5.1 Community and health . 32 2.6. Family . 33 2.6.1 Types of family. 33 2.6.2 Forms of marriage . 34 2.6.3 Kinship structure within the family . 35 2.6.4 Family’s social functions. 35 2.6.5 Fundamental family roles of its members . 36 2.6.6 Family and social support . 37 2.6.7 Resilience and family. 38 2.6.8 Family hierarchy: Inequality and power within family relations . 38 2.6.9 Domestic violence . 40 2.7. Social stratification . 40 2.7.1 Basis of stratification . 41 2.7.2 Social status . 41 2.7.3 Typology of stratification systems and social mobility. 42 2.7.4 Social class or social strata? . 43 2.7.5 Implications of stratification for health . 45 2.7.6 Racial inequalities. 48 2.8. The life course . 50 5 2.8.1 Age . 51 2.8.2 The life course perspective . 52 2.8.3 Life course and social class . 53 2.8.4 Life course perspective in the study of population health. 54 2.8.5 The life course health development framework . 55 2.9. Culture . 60 2.9.1 Core culture and subcultures . 62 2.9.2 Culture and health . 63 2.9.3 Anomie . 63 2.10 Trust . 64 2.11. Social change . 67 2.11.1 Sources of social change . 67 2.11.2 Modernity and Postmodernity . 68 2.11.3 Globalization . 68 3 SOCIAL DETERMINANTS OF HEALTH AND DISEASE (Michaela Kostičová) . 72 3.1 The history of social determinants of health . 73 3.2 Models of social determinants of health . 74 3.2.1 The Dahlgren and Whitehead health determinants model . 74 3.2.2 WHO Commission on Social Determinants of Health framework . 78 3.3 Social determinants and health inequities . 80 3.3.1 Mechanisms to social inequities in health . 81 3.3.2 Socioeconomic and political context of health inequities. 83 3.3.3 Social determinants and health inequities between and within countries. 85 3.4 Recommendations on social determinants of health inequities in Europe. 89 4 MEASURING THE HEALTH OF THE POPULATION (Michaela Kostičová) . 93 4.1 Health information system . 93 4.2 Demography . 96 4.2.1 Demographic data . 96 4.2.2 Demographic static. 99 4.2.3 Population changes – demographic dynamics . 101 4.2.4 Demographic trends and their implications for health and health care. 111 4.3 Measures of population health . 113 4.3.1 Life expectancy. 113 4.3.2 Summary measures of population health – HALE, DALYs . 114 4.3.3 Quality of life and health-related quality of life measures . 122 4.3.4 Human development index . 124 5 HEALTH POLICY (Darina Sedláková) . .129 5.1 Health in foreign policy . 130 5.2 Health policy and public health . 131 5.3 Governance for health . 133 5.4 Establishing health policy in a global society (Leonard Levy, Anthony Silvagni, Cecilia Rokusek) . 135 6 6 HEALTH SYSTEMS (Michaela Kostičová) . 143 6.1 Health financing . 144 6.1.1 Fiscal and health expenditure context . 144 6.1.2 Health financing functions . 146 6.2 Typology of health systems . 150 6.2.1 The national health service (Beveridge model) . 150 6.2.2 The social health insurance model (Bismarckian model) . 151 6.2.3 The national health insurance model. 151 6.2.4 Private health system. 151 6.3 Health system in Slovakia . 153 7 COORDINATION/INTERGRATION OF HEALTH SERVICES DELIVERY (Darina Sedláková) . 157 7.1 Aims and benefits of CIHSD. 159 7.2 CIHSD in practice. 159 7.3 Improving health outcomes through the CIHSD . 160 8 QUALITY IN HEALTH CARE (Michaela Kostičová) . 163 8.1 Definitions of quality of health care . 163 8.2 Dimensions of quality of health care . 164 8.3 Quality management in health care . 166 8.3.1.Quality measurement in health care. 166 8.3.2 Quality assurance and quality improvement in health care . 168 8.4 External models of quality management in health services . 168 8.4.1 ISO model – ISO 9000 standards. 168 8.4.2 EFQM Excellence Model . 169 8.4.3 Accreditation . 170 9 EXAMPLE PUBLIC HEALTH STRATEGY – STRATEGY TO COMBAT TUBERCULOSIS (Ivan Solovič) . 173 9.1Global level . 173 9.2 Regional level . 178 9.3 National level . 179 9.4 Local level . 180 7 PREFACE The social medicine as a scientific and interdisciplinary branch of medicine dealing with the health of the population in broader social context is the concern of all health professionals. This textbook is a study guide and makes no attempt to be a comprehen- sive description of social medicine. It was written to provide a framework for under- standing this complex field. Our goal is to introduce students to the ‘social medicine perspective’, to provide them the holistic picture as well as to introduce them to the many specialized aspects of social medicine and to allow the students to start to place their practice within the wider social context of health, and determinants of health, of the community in which they work. The chapters cover topics which we hope will en- able this goal to be achieved..