Does social medicine still matter in an era of molecular medicine?

To ask whether social medicine still matters may seem to be in poor taste a t a symposium to honor Martin Cherkasky, but social medicine has always had the courage to take on difficult questions. There is all the more reason t o do so when its legitimacy is challenged. The extraordinary findings emerg ing from the human genome project will revolutionize diagnostic and therape utic methods in medicine. The power of medical interventions, for good and for harm, will increase enormously. However, in the next millennium, as in this one, social factors will continue to be decisive for health status. Th e distribution of health and disease in human populations reflects where pe ople live, what they eat, the work they do, the air and the water they cons ume, their activity, their interconnectedness with others, and the status t hey occupy in the social order. Virchow's aphorism is as true today as it w as in 1848: "If disease is an expression of individual life under unfavorab le conditions, then epidemics must be indicative of mass disturbances of ma ss life." Increasing longevity resulting from major economic transformation s has made ours the age of chronic disease. Changes in diet and behavior tr ansform genes that once conferred selective biologic advantage into health hazards. Although disease risk varies with social status, medical care make s an important difference fur health outcomes. Access to care and the quali ty of care received are functions of social organization, the way care is f inanced, and political beliefs about the "deserving" and the "undeserving" poor. It is a moral indictment of the US that ours is the only industrializ ed society without universal health care coverage. In educating the America n public about the social determinants of health, a goal Martin Cherkasky c hampioned, the very power of the new molecular biology will help make our c ase. Social medicine is alive and well.