The Turn of the Century: Development of Social Medicine
The last decades of the nineteenth century and the first decades of the twentieth century were a period of heightened awareness in both the United States and Europe of the need for social programs to respond to health crises. These were years of social upheaval caused in part by the effects of the Industrial Revolution and rapid urban growth (and, in the United States, a tremendous influx of largely poor and unskilled immigrants). In 1915, Alfred Grotjahn published a classic work, Soziale Pathologie, documenting the role of social factors in disease and illness and urging the development of a social science framework for working with communities and providers in reducing health problems. The term social medicine was coined to refer to efforts to improve public health.
However, an important crosscurrent was occurring simultaneously. The discovery of the germ theory of disease enabled physicians to more successfully treat the acute infectious diseases that plagued society. This reinforced a belief that medicine could rely solely on biological science. The discipline of sociology was still in its infancy and was not able to provide sufficient documentation of the need for a complementary focus on social conditions.
The 1950s and 1960s: The Formal Subdiscipline Emerges
The emergence of medical sociology as a field of study occurred in the 1950s and 1960s. The most important developments then pertain to changes in health, healing, and illness, external recognition of the field, and its institutionalization within sociology.
Changes in Health, Healing, and Illness. Based on analysis by Rodney Coe (1970) and others, the development of medical sociology was facilitated by four changes that had occurred or were occurring in medicine in the 1950s and 1960s. These are as follows:
1. Changing patterns of morbidity and mortality. During this time, the primary causes of sickness and death shifted from acute infectious diseases (e.g., influenza and tuberculosis) to chronic, degenerative diseases (e.g., heart disease and cancer). Because the factors that lead to degenerative diseases are more obviously interwoven with social patterns and lifestyle, the necessity for sociological contributions became more apparent.
2. The impact of preventive medicine and public health. In the 1800s and early 1900s, the field of public health focused primarily on bacteriology (linking particular germs to diseases) and immunology (preventing disease occurrence). As the twentieth century progressed, however, it became apparent that protection of public health also required consideration of social factors such as poverty, malnutrition, and congested living areas—all of obvious interest to sociologists.
3. The impact of modern psychiatry. The development of the field of psychiatry led to increased interest in the psychophysiological basis for many diseases and illnesses, in the importance of effective interaction between patients and practitioners, and in the use of patients’ social environment as part of therapy.
4. The impact of administrative medicine. Throughout the twentieth century, the organizational complexity of the medical field—in the settings in which care is delivered, in the ownership of medical facilities, and in the bureaucracies that were created to regulate and finance medical care—expanded enormously. The abilities of sociologists to analyze organizations and structures, identify those who are harmed as well as those who gain by various arrangements, and examine the consequences of alternative techniques were increasingly useful skills in organizationally complex environments.
External Recognition and Legitimation. Two key events during the 1950s and 1960s contributed to the increased interest in and legitimation of medical sociology. First, medical schools began to hire sociologists for their faculties. Although medical sociology was not always well integrated into the curriculum, the move symbolized an increasing recognition of sociology’s potential contribution to understanding disease and illness. Second, government agencies and private foundations initiated significant financial funding for medical sociology. The National Institutes of Health and the National Institute of Mental Health sponsored sociological research in medicine and subsidized training programs for graduate students in sociology. (Both authors of this book received fellowships from the U.S. Public Health Service for their graduate education.) The Russell Sage Foundation provided significant funding of programs to increase the use of social science research within medicine.
Institutionalization of Medical Sociology. Finally, two additional events are especially noteworthy in the institutionalization of medical sociology. In 1959, medical sociology was accepted as a formal section of the ASA—an important step in bringing recognition to a field and enabling recruitment of new members. Second, in 1965, the ASA assumed control of an existing journal in medical sociology and renamed it the Journal of Health and Social Behavior. Now the official ASA journal for medical sociology, it is a key mechanism for medical sociologists to share their research findings.
Since then the field has flourished. The ASA section on medical sociology currently has approximately 1,000 members (there are about 13,000 ASA members), and is the third largest special interest section within the association. Medical sociologists publish in a wide variety of journals in sociology, public health, and medicine, and are increasingly employed in health planning, community health education, education of health professionals, government at all levels, and health care administration in addition to colleges and universities. See the “In the Field” box on Major Topics in Medical Sociology for one way of organizing...