Academic journal article Bulletin of the World Health Organization

When Medicine Rediscoverd Its Social Roots

Academic journal article Bulletin of the World Health Organization

When Medicine Rediscoverd Its Social Roots

Article excerpt

Hippocrates wrote in about 400 BC: "Whoever wishes to investigate medicine properly should proceed thus: in the first place to consider the seasons of the year. Then the winds. In the same manner, when one comes into a city in which he is a stranger, he should consider its situation, the water which the inhabitants use ... and the mode in which the inhabitants live, and what are their pursuits."

At least since the time of Hippocrates, medicine has been practised in a social context. The conditions in which people live and the ways in which they behave have been of great significance, as medicine is a profession for both care and cure.

Then came the age of biology and technology. Spectacular scientific advances had a tremendous impact on the practice of medicine. On the positive side, physicians had tools to achieve curative wonders in ways that were never available before. But on the negative side, the more physicians became technically oriented, the less they were socially conscious. As they learned more about cell and molecular biology, they tended to forget that these molecules and cells constitute human beings with a life of their own. Machines stood between physicians and their patients. Medicine lost its "pastoral" function of administering tender loving care to the anxious patient.

The paper by Professor Baird is a public health classic in the sense that it attempts to bring back the social perspective to the practice of medicine (1). When asked to give a lecture on preventive obstetrics, he used the platform to highlight the impact of social factors on the health of mothers and children and to give voice to women's perceptions of "modern" medical practice. The words he quoted probably still echo today: "There is a lot to be said for the old-fashioned doctors. I am sure they would have been a lot more helpful.... Excuse criticism, but I feel very strongly about it."

It is not strange that this call for social consciousness in medicine should come from the field of obstetrics. The social perspective is relevant to all areas of health care, but it is the more vulnerable groups who suffer most from the lack of it, and children and women are among the first of these. As Baird tightly remarks, "any deterioration in living standards is reflected immediately in a rise in mortality in the period of one to twelve months". Maternal mortality likewise: there is no other health indicator with such a discrepancy between the rich and the poor. The lifetime risk of a woman dying from pregnancy and childbirth ranges from less than 1 in 10 in some African countries to 1 in several thousand in European countries (1 in 8700 in Switzerland, for example) (2).

The socioeconomic conditions that had an adverse impact on the reproductive performance of women in the city of Aberdeen in the 1940s and 1950s still have that impact on the health and lives of hundreds of millions of women and their babies in developing countries in the world today. Every year, about 9 million babies are either born dead or die within the first 28 days of life (3).

Experience in the past few decades has taught us three important lessons. The first is that while the poor fare worse than the better-off on all health indicators, some countries attain far better health conditions for their poor people than others (4)? Poverty is not an insurmountable barrier to health when policies are right.

The second lesson is that gender has a lot to do with it. Awareness of gender as a health determinant is relatively recent. When the founders drafted the Constitution of the World Health Organization more than fifty years ago, they wrote: "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition". They forgot one thing: distinction of sex. Dugald Baird, in highlighting that tall women are more efficient in reproduction than small women, states: "many women are small not because of heredity but because they are stunted and not fully grown (possibly as a result of faulty living conditions and deficient diet in the growing years)". …

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