Social medicine and social policy.

Social medicine as a term has achieved acceptance in medical education and medical practice, although there is still some question as to its acceptance in reality. The term had its origin in the vigorous nineteenth-century efforts at both medical and social reform, combining the two in a recognition of the intimate connection between social factors and the causation of disease. Henry Ernest Sigerist, a Swiss physician and noted scholar of medical history, formulated the broadest concept in the 1930s, attracting students and a latent American reform movement toward the idea of restructuring medical education as one part of social reform, and indicating ways of restructuring medical practice as another element in improving medical care at the same time. In addition to promulgating the doctrine, he established the policy of examining and describing systems of medical education and medical care in other parts of the world, not only to assist in improving medical care in countries with well-organized systems, but to assist countries with poor resources and lesser organizational capability in meeting the goals of social medicine. Doubt as to the durability of the concept has been expressed, insofar as the recommended improvements have lagged behind the expression, and because so many changes have taken place in the nature of medical practice, medical discoveries, and advances in technology. A closer examination of Sigerist's writings on the subject and evaluation of the circumstances around present-day problems would seem to indicate that the flaw is not in the doctrine, but in the lack of social application.