A Country Doctor Writes:

Many Americans have had a negative feeling about the word “social” because of their fears of too much government control, as in socialized medicine or even socialism.

As a Swede with a more neutral sense of the word, although I never identified with the socialist political party, I startled when the pandemic brought us the concept of social distancing. That felt like a complete oxymoron. How could keeping a six foot distance to other human beings be a social act?

But, of course, keeping your distance out of consideration for others is a socially responsible and appropriate thing to do. My ears were just not used to hearing the S-word in English.

Swedes don’t use the expression “socialized medicine”, because health care is viewed as a human right and people don’t imagine that a private system could provide care for all of society—notice the similarity between the words society, social and socialism. So they think it is a no-brainer that health care needs to be a service provided by the government for everyone. There is simply no concept of “desocialized” health care, or whatever you would call health care that was entirely privately run.

Socialmedicin, in Sweden, is a broader field than what Americans call Public Health. Its focus on the socioeconomic determinants of health is more obvious than what I usually hear in this country. Other “social” words in the Swedish welfare state vocabulary (and my mother tongue has a visually powerful custom of making one word out of two, as in healthcare versus health care) are:

Socialarbetare (social worker), Socialvård (welfare in its broadest sense) Socialnämnd (Social Board that oversees the welfare of minors, like DHHS here), Socialstyrelsen (National Board of Health and Welfare) Socialfall (Social case, as in the legitimate admission diagnosis “causa socialis” when I worked in Sweden and someone wasn’t safe at home and the hospital was their only option).

The pandemic has brought us one giant leap forward in our understanding that biochemical and sociopolitical factors can converge to cause disease and that both sets of factors are equally necessary to save us from it.

Rudolf Virchow, the father of modern pathology, is also considered the father of social medicine. Interestingly, pathology and social medicine have diverged since his lifetime and medicine has strayed far from his vision. In this century, the American Physician Paul Farmer and others are trying to bring these models together:

Because of contact with patients, physicians readily appreciate that large-scale social forces—racism, gender inequality, poverty, political violence and war, and sometimes the very policies that address them—often determine who falls ill and who has access to care. For practitioners of public health, the social determinants of disease are even harder to disregard.

The holy grail of modern medicine remains the search for a molecular basis of disease. While the practical yield of such circumscribed inquiry has been enormous, exclusive focus on molecular-level phenomena has contributed to the increasing “desocialization” of scientific inquiry: a tendency to ask only biological questions about what are in fact biosocial phenomena.

The time is more than ripe for us here in America to pay more serious attention to the biosocial and biopsychosocial determinants of health and disease.