The future of social medicine

The future of social medicine is based on 150 years of history and the rapi dly evolving context within which medicine functions in modern societies. T here are two views of social medicine. One is based on the vision of Guerin and, particularly, Virchow 150 years ago that: "Doctors are the natural ad vocates of the poor, and social problems are largely within their jurisdict ion." The New York Academy of Medicine's Institute on Social Medicine 50 ye ars ago reflected this broad view. Medicine, however, enamored of the biome dical paradigm and the advances in knowledge through biomedical research, l argely abandoned this broad perspective, even as the knowledge about the so cial, behavioral, and environmental determinants of health was advancing ra pidly. A second view of social medicine, and one that has influenced many i n the past 30 years, was defined by McKeown and Lowe: "Social medicine is c oncerned with a body of knowledge and methods of obtaining knowledge approp riate to a discipline. This discipline may be said to comprise (a) epidemio logy, and (b) the study of the medical needs of society, or in the contempo rary short hand medical care." Social medicine, in my view, includes not on ly the definition of McKeown and Lowe, but the broader context within which medicine fits in society. The context is changing. The social contract as defined by Bismarck and Beveridge has to be redefined. Just as the New York Academy of Medicine provided the vision of social medicine 50 years ago, t he Academy has given us a new vision with the publication of Medicine and P ublic Health: the Power of Collaboration in 1997. Authored by Dr. Rot Laske r, director of the Academy's Division of Public Health, the beak identifies the key changes required by medicine and public health to advance the goal s of medicine and public health for the benefit of both individual patients and the population as a whole. The book points the way for the future of s ocial medicine by identifying not only what needs to be done, but also how to do it.