Michael L. TanJune 2009

Social MedicineThe applications of the social sciences and

humanities toward an understanding of medicine and health care.

Social SciencesAnthropology (and archaeology)DemographyEconomicsGeographyHistoryLinguisticsPolitical sciencePsychologySociology

HumanitiesArtsLiteratureClassicsPhilosophyReligious studies(There are overlaps with the social sciences,

eg history and anthropology are often cited as being part of the humanities as well.)

Why social sciences in medicine?“Medicine is a social science, and politics is

nothing but medicine on a large scale.”

“It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation.”

“My politics were those of prophylaxis, my opponents preferred those of palliation.”

-Rudolf Ludwig Virchow (1821-1902), Physician, public health advocate, anthropologist

The social sciences provide tools for:Analyzing health and illnessDeveloping greater competencies (especially

cultural competence)Developing a more critical and discerning

science.

1. Analyzing health, culture and societyUrie Bronfenbrenner’s nested ecological

model or social ecological model points out different levels for analysis:Micro or individual or interpersonal level,

including the familyMeso level: organizational level (eg faith-based

institutions, schools) where enculturation and socialization take place

Nested ecological model (con’td)

Exo level: community level (geographical or virtual)

Macro level: large structures such as government, faith-based institutions, mass media

Cutting across these levels are:Ecological factors (interactions between

humans and the natural environment)History

Lens from the social sciences & humanities

Micro: health psychology theories looking into

behavior changePhenomenological/interpretivist perspectives

looking into meanings and experiences, how we make sense of the world (anthropology and the humanities emphasize the biocultural interfaces/predispositions as well)

Economics often looks into individual motivations, eg the “nudge” factor

Levels/lensesMeso level: peers, organizations

Sociology and anthropology offer social interactionist perspectives looking into how we socialize, how culture becomes habitus or kaugalian

Political science offers social capital theories that look into how we build networks of knowledge and trust that can be passed inter-generationally

Levels/lensesExo: the community

Again, social interactionist theories help us to understand who we develop a sense of community, and how such affiliations affect/reinforce/challenge behaviors around health. The four B’s are an example of powerful exo factors at work (bantay, bisita, baon, balot).

Levels/lensesMacro: “big picture”

Political economy looks at power relations, across classes, ethnicities, castes, and how these shape access to resources. In the area of medicine, political economy looks at health policies, budgets, ideologies.

Levels/lensesHuman-environment relations

Demography looks at how populations and population movements affect health and illness.

Geography focuses on perceptions of and utilization of spaces, and how this impacts on health and illness. (How do we react when we see many people?)

Cultural ecology (from anthropology) looks at how cultures are shaped and reshaped in response to the environment.

Levels/lensesHistory: cuts through all the levels, offering

perspectives across time.

2. Cultural competenceCultural competence is defined as an ongoing

process by which individuals and systems respond respectfully and effectively to people

of all cultures, languages, classes, races, sexes, ethnic backgrounds, religions, sexual

orientations, abilities and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families, and communities and protects and preserves the dignity of each.” (US National Association of Social Workers, 2001)

Why cultural competence?We live in a multicultural world. Think of the

diversity in the Philippines:170 languages (8 with at least 1 million

speakers)3 major religionsWide disparities in socioeconomic statusAt least 7 genders (More in another lecture)

Why cultural competence?• A diaspora that is creating all kinds of mestizo

populations and cultures, as well as Filipinos working with nearly every known culture in the world.

Ethnocentrism vs cultural relativismEthnocentrism: Judging other people’s beliefs

and practices using our own cultural norms and standards. This hampers the development of cultural competence.

Cultural relativism: Understanding that there are social, historical and even environmental contexts to culture. There are debates on how far we can go with cultural relativism.

Cultural competence and medical practiceCultural competence means

Enhanced clinical competenceGreater efficiency in administrative functionsWider “clientele”

Some caveats:Cultures are not homogenous and static.The social sciences should not teach you to

manipulate patients. Move from the idea of patient compliance to patient adherence.

3. A critical and discerning sciencePhysicians, like many natural and physical

scientists, tend toward absolutes and dogmatism. The social sciences help sharpen the mind, awaken the spirit, keep you critical and discerning.

While the social sciences can help to develop medicine, think too of how medicine might help to explain social phenomena, and harness more of these social phenomena for health care.

Hallmarks in 21st century scienceEvidence-based

Translational (bench to bedside)