Chapter 1. Goals and objectives in sociology of medicine
1.1. Medico-sociological views on medicine, healthcare, and the health protection system
Medicine is an integrated system of scientific knowledge and practical activity aimed at strengthening and maintenance of health, prolongation of the human life span, as well as prevention and treatment of human diseases. To implement these tasks, medicine examines 1) the biological structures and physiological processes under normal and pathological conditions; 2) the positive and negative effects of natural and social environments on human health; 3) human diseases (the causes, mechanisms of genesis, development, and symptoms), and 4) the possibilities to use diverse physical, chemical, and biological factors and technical facilities to prevent, reveal, and treat diseases1.
Public health is a system of governmental and public socioeconomic and medical measures directed to maintain and improve public health2.
The healthcare system is a set of interacting legal parties and institutes of society organized to implement the political, economic, legal, social, scientific, medical, and sanitary-hygienic measures directed to protect, maintain, and strengthen public health and to prevent diseases.
Before 1970−1980, the achievements of the healthcare system can be explained by the progress in preventing acute infectious diseases. After the development of public healthcare, the most urgent healthcare tasks have been shifted to prevention medicine. Approaches to the problems of health and disease changed dramatically with more emphasis being placed now on the social environment of human beings. Modern research greatly expanded the studies of social phenomena determining public health, reproduction of population, and related problems, which are carried out on the basis of comprehensive medico-sociological analysis.
The modern system of health protection and strengthening is not only responsible for numerous social functions, but it is presently transforming into a centralized implementation of social ideology (formation of the healthy life-style included), which should gradually elaborate the methodology to reflect the sociomedical phenomena corresponding to human needs in social cognition. Specifically, it should provide the tools to use diverse social achievements, which moderate or, on the contrary, strengthen the intellectual and physical activity, general state (self-estimation of wellbeing), affect the health, and prevent undesirable trends in the development of medicine.
In the modern world, medicine and healthcare play exclusive roles in human life and constitute the most important sphere of human activity. Sometimes, their impact on everyday life is even stronger than that of politics and economics. Therefore, the necessity in medico-sociological research work enhanced dramatically in order 1) to explain the character of sociomedical interrelations and interactions; 2) to elaborate the models to examine the control principles as well as to simulate and to prognosticate the processes in the healthcare system; and 3) to promote creation of the adequate system of public healthcare with due account for the socioeconomic realities.
Acknowledgement of the social systemic character of medicine, medical practice, and healthcare, as well as general consensus on the important role of examination of sociomedical, economic, and political problems of public healthcare, were reflected in the 20th century by the emergence and logical development of the novel scientific branch, sociology of medicine. This science originated as an interface between sociology and medicine designed to solve problems, which became evident when the researchers realized that the system of health protection and its strengthening affects not only an individual person, but society as a whole. Initially, sociology of medicine was merely a branch of sociology, but in the following it grew into a self-consistent academic discipline. This is a well-known fate of many other scientific branches: for instance, biophysics and biochemistry made their first steps by applying the physical and chemical methods to study the phenomena in animate nature, but then they became important and independent sciences examining not only the borderline phenomena, but trying to integrate biology with the cornerstone branches of natural philosophy.
The mutual influences of various sciences that were not always allied attest to the profound changes in the general structure of scientific knowledge. The conventional character of the borderlines between the sciences is reflected in the persistent changes of their boundaries and interrelations, which should be taken into consideration to make the correct prognoses and to shape the general development of the scientific process. It is noteworthy that the novel areas of scientific research are opened by transformation of the sociological methods that can be applied to the medical problems into the potent research tools with preservation and the development of their applied potential.
One can highlight the following factors, which integrate medicine and sociology and promote the development of sociology of medicine into an independent academic discipline:
- the state of social anomia during reincarnation of the market economy in the RF;
- the need in medico-sociological comprehension of the role and place of the healthcare system in the life of society based on the use of sociological methods to examine this system;
- the current changes in the demographic processes and in the structure of morbidity manifested by population aging, natural population loss, chronization of the diseases, etc.);
- the need to use the sociological approaches in the study of diseases and treatment.
The subject of sociology of medicine is the attitude of the individuals and social groups towards the state of public health and organization of medical aid in dependence on socioeconomic and political factors. In other words, this science examines the relations of human beings and social groups to the problems of diseases-and-treatment and to organization-and-control in the healthcare system as a social institution in close cooperation with other structural elements of the society.