SOCIAL MEDICINE

LESSON PLAN
1.OBJECT, SUBJECT AND TASK OF SOCIAL
MEDICINE.
2. INDIVIDUAL AND PUBLIC HEALTH.
HEALTH LEVELS.
3.PSYCHOSOMATIC ILLNESSES AND
ADDICTIVE BEHAVIOR

shape
Social
environment
for a person
culture, state,
TV, social
networks,
advertising
social circle: family,
friend, neighbors
educational
environment: school,
university
human needs
or
dissatisfaction
the picture of
the human
world
comprises

Social environment is as important as the physical and biological environment
in relation to health and disease. The effect of social environment on health is
clearly reflected in the differences in the health of the populations between
and within countries.
This environment is unique to man and includes cultural values, customs,
habits, beliefs, attitudes, morals, religion, education, income, occupation,
standard of living, community life and the social and political
organizations.
Сonclusions “What is Social environment?”

About “Social medicine” is based on three fundamental questions:
1. What is the health of the population?
2. Why is it so?
3. How to improve health?
Social medicine is a scientific, interdisciplinary branch of medicine that studies the health of the
population and the system of health care in broader social context . Social medicine contributes to
understanding the determinants of health and how best to apply that knowledge to improve the
health of the population.
The scientific and methodological base of social medicine is primarily epidemiology together with
biostatistics as well as social psychology, sociology, law, economy,managerial sciences, philosophy
and history.

The aim of social medicine is to improve the health of the population
by understanding and influencing the determinants of health. To
meet this goal, it is important not only to identify determinants of
health, but also to analyze their effectiveness and to know the
relation between them and the way they are influencing the health.
*from lat. determinans - defining

Health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity.
When we think about health, we tend to think about it in purely
physical or biological terms. However, health is also a major social
issue due to the fact that many of the causes of illness are directly
affected by social factors. The social aspect of health is also
a part of the World Health Organization (WHO 1948) definition of
health.

The ongoing processes of health
development can be observed, analysed and intentionally influenced from at least two
different but complementary perspectives:
1. Pathogenesis analyses how risk factors of individuals and their environment
lead to ill health (illness, disease, disability).
2. Salutogenesis examines how resources in human life support development
towards positive health (objective fitness, subjective well-being, optimal functioning,
meaningful life and positive quality of life).
In real life, salutogenesis and pathogenesis are simultaneous, complementary and
interacting real life processes. Human beings have to (re)produce their health
continuously in time, making use of resources to maintain their identity against risk
factors.
Health is also the output of actual living and input into future living, so current health
status determines future health.

HEALTH LEVELS
Individual health public health
is the health of the
population, society as a
whole.

Individual health and public health are inseparable. In
order to promote individual health, physicians must also
promote public health by thinking globally and
functioning as medical sociologists, who value human
rights, quality of life, social justice, international
relations, and world peace
How is individual health related to public health?

Society and any social group is more than the sum of its parts. By being a part of
a nation, a social group, or a crowd, something new and different arises that
transcends the characteristics of the individual. Rules and expectations evolve
from the interaction of individuals. Studies documented that individuals as part
of a group (e.g. peer teenage group) behave differently and do things that would
never have been even occured to them as individuals. Would any reasonable
person embark on a potentially dangerous crash diet, or piercing, if it were not for
the influence of the social group?
Individual society members have a limited ability to influence the nature of
society. As R. K. Thomas pointed out, people are born into a game that is already
underway and have limited influence over the rules, however, there can occur an
occasional revolutionary who makes a major impact on society, e.g. Martin Luther,
Martin Luther King, K. Marx.

Risk factors or risk conditions. These cause health problems and diseases that
are potentially preventable. These risk factors or risk conditions can be social or
economic or can be associated with specific environmental or lifestyle-related health
hazards, such as polluted air and smoking.
In practice, making the distinction between these categories of determinants may
be difficult at times. As the focus is typically on risk factors, it is useful to try to
identify
positive and protective factors.
It is generally accepted that the determinants of health include
• the physical environment—natural and built;
• the social environment;
• individual behaviour;
• human biology;
• health system.

We can define disease as an objective, ascertainable set of symptoms
creating a settled clinical entity – diagnosis, classified according to
international standard diagnostic
classification (ICD) presented at the end of this chapter.
In the context of negative health we use also term disability – the umbrella
term for
impairments, activity limitations and participation restrictions.
International classification of functioning and disability (ICF) classifies
functioning and disability associated
with health conditions.
The criteria for disease are:
• Manifestation: symptomatology
• Type: organic, functional, psycho-social
• Dynamism: acute, chronic
• Development: latent – asymptomatic, unapparent, subclinical; manifest
– apparent
• Prognosis: good (favourable), unchangeable, unfavourable (bad)

PSYCHOSOMATIC
disorder is a psychological condition involving the occurrence of
physical symptoms, usually lacking a medical explanation.
People with this condition may have excessive thoughts,
feelings or concerns about the symptoms — which affects their
ability to function well.

Psychosomatic illnesses can be classified in three general forms.
The first form includes those who experience both a mental illness and a
medical one; these illnesses complicate the symptoms and management of
each other.
The second form includes those who experience a psychiatric issue that is a
direct result of a medical illness or its treatment; having depression due to
cancer and its treatment for example.
The third form of psychosomatic illness is, 'somatoform,' disorders.
Somatoform disorders are psychiatric ones that are displayed through
physical issues. What this means is the physical symptoms people
experience are related to psychological factors instead of a medical cause.

Somatoform disorders may include the following:
Somatization Disorder: A disorder in which a person experiences physical
complaints such as diarrhea, headaches, premature ejaculation, or ones that
do not have a physical cause.
Conversion Disorder: A disorder in which a person experiences neurological
symptoms affecting their movement and senses which do not seem to have a
physical cause. Symptoms may include blindness, seizures, or paralysis.

Body Dysmorphic Disorder: An obsession or preoccupation with an imaginary
or minor flaw such as wrinkles, small breasts, or the size or shape of another
part of the person's body. Body dysmorphic disorder causes severe anxiety and
might impact a person's ability to function as usual in their daily life.
Hypochondriasis: A fixation or obsession with the fear of having a serious form
of disease. People with hypochondriasis misconstrue usual body functions or
minor symptoms as being serious or even life-threatening. A person; for
example, with hypochondriasis might become convinced that they have colon
cancer when experiencing temporary flatulence after consuming cabbage.

There is a mental aspect to every physical disease.
The term,
'psychosomatic
disorder;' however, is
mainly used to mean
a physical disease
that is believed to be
caused, or worsened,
by mental factors.

When a person is anxious or afraid; for example, they might develop:
Tremor
Nausea
Sweating
Dry mouth
Headaches
Chest pains
Palpitations
Increased heart rate
A, 'knot,' in the stomach
Increased breathing rate
Causes
The exact way a person's mind may cause certain additional symptoms remains
unclear. How a person's mind can affect actual physical diseases is not known with
certainty. It might have something to do with nervous impulses going to the
person's body, which is not fully understood. There is some evidence the brain
might have the ability to affect certain cells of the immune system, something
involved in various physical diseases.

Symptoms
Somatoform disorders are the major forms of psychosomatic
illness. The physical symptoms of somatoform disorders are all too
real, they have psychological roots instead of physical causes.
Somatoform disorders include:
Hypochondriasis
Conversion disorder
Somatization disorder
Body dysmorphic disorder

Hypochondriasis is the condition of thinking that usual body functions or minor
symptoms represent a serious medical condition. A person with hypochondriasis
may interpret a headache as a brain tumor, or muscle soreness as a sign of
impending paralysis. Common symptoms of hypochondriasis can include:
Anxiety
Depression
Repeated visits to a doctor until a diagnosis is made
Feeling that a doctor has made a mistake by not diagnosing the cause of the
symptoms
Seeking constant reassurance from family members and friends about the
symptoms they experience
F45.2

Conversion Disorder Symptoms
The symptoms of conversion disorder usually look like neurological
issues and can include double vision or blindness, loss of sensation,
difficulties with swallowing, and impaired coordination or balance.
The symptoms a person with conversion disorder may experience also
include seizures, issues with urinary retention, an inability to speak,
paralysis or weakness.

The disorders may cause difficulties in a person's everyday life to include academic, social and
occupational issues. People who experience body dysmorphic disorder can become obsessed
with what are actually minor flaws in their physical appearance, or might perceive flaws
where none actually exist. Common concerns include the loss of hair, the shape and size of
bodily features such as nose, breast, or eye appearance, as well as wrinkles and weight gain.
Symptoms and associated behaviors of body dysmorphic disorder can include the following:
• Avoiding mirrors
• Depression and anxiety
• Avoiding being seen in public
• Withdrawal from social situations
• Constant checking of appearance in a mirror
• Desiring reassurance from others about the person's appearance
Body dysmorphic disorder

Somatization disorder is characterized by physical symptoms without a physical cause.
Somatization disorder may have some different symptoms. These symptoms can include the
following:
Pain
Fatigue
Nausea
Diarrhea
Vomiting
Headache
Constipation
Abdominal pain
Painful intercourse
Painful menstruation

How is psychosomatic disorder diagnosed?
A healthcare provider can begin to diagnose
psychosomatic disorder based on:
History of visits to healthcare providers.
Physical exam.
Series of negative results on tests.

To be diagnosed with somatic symptom disorder, a person must
have:
One or more symptoms that are distressing or disruptive to
daily life.
A history of those symptoms for at least six months.
Persistent thoughts, worries or anxiety about the symptoms.

How are psychosomatic pain and other somatic symptoms treated?
Several treatments can help people with somatic pain symptoms, including:
• Cognitive behavioral therapy.
• Medications, such as antidepressants.
• Mindfulness-based therapy.
• Referral to a specialist in mental health (for example, a psychiatrist or
psychologist).
• Regular contact with your primary care provider.