[Ethics and social medicine: Michel Foucault's perspective]. / La ética y la medicina social: la perspectiva de Michel Foucault.

Michel Foucault's preoccupation with medicine, its history and its impact on society, is a constant in his work. The goal of this study is to contrast the content of the lectures Foucault gave in Rio de Janeiro, in October 1974, with the preparatory notes for them which are part of the archival holdings acquired by the National Library of France. One of the key questions in those lectures is the relationship between ethics and contemporary social medicine. This question, analyzed from Foucault's point of view, constitutes the background and ultimate interest of this article.

La preocupación de Michel Foucault por la medicina, su historia y su impacto en la sociedad, es una constante en su obra. El objetivo de este trabajo es contrastar el contenido de las conferencias que Foucault impartió en Río de Janeiro, en octubre de 1974, con los materiales preparatorios de las mismas que forman parte de los fondos adquiridos por la Biblioteca Nacional de Francia. Una de las cuestiones clave en dichas conferencias es la relación entre la ética y la medicina social contemporánea. Esa cuestión, analizada desde el punto de vista de Foucault, constituye el trasfondo e interés último del presente trabajo.

La ética y la medicina social: la perspectiva de Michel Foucault / Ethics and social medicine: Michel Foucault's perspective

Resumen La preocupación de Michel Foucault por la medicina, su historia y su impacto en la sociedad, es una constante en su obra. El objetivo de este trabajo es contrastar el contenido de las conferencias que Foucault impartió en Río de Janeiro, en octubre de 1974, con los materiales preparatorios de las mismas que forman parte de los fondos adquiridos por la Biblioteca Nacional de Francia. Una de las cuestiones clave en dichas conferencias es la relación entre la ética y la medicina social contemporánea. Esa cuestión, analizada desde el punto de vista de Foucault, constituye el trasfondo e interés último del presente trabajo.

Abstract Michel Foucault's preoccupation with medicine, its history and its impact on society, is a constant in his work. The goal of this study is to contrast the content of the lectures Foucault gave in Rio de Janeiro, in October 1974, with the preparatory notes for them which are part of the archival holdings acquired by the National Library of France. One of the key questions in those lectures is the relationship between ethics and contemporary social medicine. This question, analyzed from Foucault's point of view, constitutes the background and ultimate interest of this article.

Diego Rivera, The History of Medicine in Mexico: Peopled Demand for Better Health, mural in 1953 still current.

Although public health and social medicine have a long history in Latin America going back to Co lonial times, their relevance has ebbed and flowed as a result of the development of a variety of social and political movements. The Mexican Revolution accelerated implementation of public health po licies in Mexico and resulted in the creation of the Mexican Institute of Social Security to serve the health and social security needs of the country's population. Construction of the Hospital La Raza and its embellishment by the mural paintings of Diego Rivera and David Alfaro Siqueiros correspon ded to the heyday of public health ideas in Mexico. This is clearly reflected in Rivera's mural painting from 1953, The History of Medicine in Mexico: People's Demand for Better Health. The left side of the painting, representing the history of modern medicine in Mexico, exemplifies the tensions between individuals and social groups demanding the fruits of modern medicine and public health, and en trenched bureaucracy and private interests resisting their demands. Rivera's artistry illustrates this tension by depicting urban social groups and a family with a pregnant mother and children reques ting medical attention on one side of the main panel, facing condescending physicians, bureaucrats and upper society gentlemen and ladies on the other side. The importance of social movements to the development of public health policies illustrated by Rivera in 1953 continues to be relevant in Latin America today where increasing millions still lack the benefits of health care and social security.

Diego Rivera, the history of medicine in Mexico: peopled demand for better health, mural in 1953 still current / Diego Rivera: la historia de la medicina en México: el pueblo en demanda de salud, mural de 1953 aún vigente

Abstract: Although public health and social medicine have a long history in Latin America going back to Co lonial times, their relevance has ebbed and flowed as a result of the development of a variety of social and political movements. The Mexican Revolution accelerated implementation of public health po licies in Mexico and resulted in the creation of the Mexican Institute of Social Security to serve the health and social security needs of the country's population. Construction of the Hospital La Raza and its embellishment by the mural paintings of Diego Rivera and David Alfaro Siqueiros correspon ded to the heyday of public health ideas in Mexico. This is clearly reflected in Rivera's mural painting from 1953, The History of Medicine in Mexico: People's Demand for Better Health. The left side of the painting, representing the history of modern medicine in Mexico, exemplifies the tensions between individuals and social groups demanding the fruits of modern medicine and public health, and en trenched bureaucracy and private interests resisting their demands. Rivera's artistry illustrates this tension by depicting urban social groups and a family with a pregnant mother and children reques ting medical attention on one side of the main panel, facing condescending physicians, bureaucrats and upper society gentlemen and ladies on the other side. The importance of social movements to the development of public health policies illustrated by Rivera in 1953 continues to be relevant in Latin America today where increasing millions still lack the benefits of health care and social security.

Social medicine and international expert networks in Latin America, 1930-1945.

This paper examines the international networks that influenced ideas and policy in social medicine in the 1930s and 1940s in Latin America, focusing on institutional networks organised by the League of Nations Health Organization, the International Labour Organization, and the Pan-American Sanitary Bureau. After examining the architecture of these networks, this paper traces their influence on social and health policy in two policy domains: social security and nutrition. Closer scrutiny of a series of international conferences and local media accounts of them reveals that international networks were not just 'conveyor belts' for policy ideas from the industrialised countries of the US and Europe into Latin America; rather, there was often contentious debate over the relevance and appropriateness of health and social policy models in the Latin American context. Recognition of difference between Latin America and the global economic core regions was a key impetus for seeking 'national solutions to national problems' in countries like Argentina and Chile, even as integration into these networks provided progressive doctors, scientists, and other intellectuals important international support for local political reforms.

"Imagine All the People:" Andrija Stampar's Ideology in The Context of Contemporary Public Health Initiatives

Recently, the World Health Organization launched its Universal Health Coverage initiative with the aim to improve access to quality health care on a global level, without causing financial hardship to the patients. In this paper, we will identify and analyze the ideological similarities between this influential initiative and the work of one of the founders of the WHO-Andrija Stampar (1888-1958)-whose social medicine was built of various normative, sociological and philosophical elements. Our aim is to demonstrate the crucial role of carefully erected and thought-out ideology for the success of public health programs.

Origins and Evolution of Social Medicine and Contemporary Social Medicine in Korea.

Social medicine is recognized as one of medical specialties in many countries. However, social medicine has never been formally introduced to Korea, presumably because the term and its principles were not accepted for some years in the past in American medicine, which has strongly influenced Korean medicine. This paper describes the origins and evolution of social medicine and briefly discusses contemporary social medicine in Korea. Social medicine was initiated in France and Germany in 1848. Since then, it has expanded globally and developed in diverse ways. Included in core principles of social medicine is that social and economic conditions have important effects on health and disease, and that these relationships must be subjected to scientific investigation. The term 'social medicine' is rarely used in Korea, but many of its subject matters are incorporated into preventive medicine which, besides prevention, deals with population health that is inescapably social. However, the Korean preventive medicine directs little attention to the basic concepts and principles of social medicine, upon which systematic development of social medicine can be based. Thus, it is necessary to supplement the social medicine contents of preventive medicine through formalizing the linkages between the two fields. One way of doing so would be to change the title of 'preventive medicine' course in medical colleges to 'preventive and social medicine,' as in many other countries, and to adjust the course contents accordingly.

The Political Future of Social Medicine: Reflections on Physicians as Activists.

The academic discipline of social medicine has always had a political and policy advocacy component, in addition to its core functions of research and teaching. Its origins lie in the 18th and 19th centuries, in the work of Johann Peter Frank and Rudolph Virchow, among others. Virchow's dictum that "politics is nothing else but medicine on a large scale" highlights that most social determinants of health are politically determined and shape population health. Yet despite intense epidemiological and sociological research on the social determinants of health, less attention has been paid to this political and policy dimension.During the 1960s, the author and many other clinicians were directly involved in attempts to use health care institutions to foster structural change. However, the author argues that efforts to assist individual patients and more effectively manage their interactions with the health care system, as described in the articles in this issue's special collection on "structural competency," while worthy and useful, do not confront root causes. Going forward, efforts to effect structural change must take place outside the arena of the clinical encounter and involve interprofessional teams and collaborations with nongovernmental organizations. They should intervene directly on the structures that contribute to illness such as poor housing, income and wealth inequality, inferior education, racism and residential segregation, and toxic concentrations of extreme poverty in urban areas. Collectively, these efforts-within and outside the spheres of medicine-represent the real operative form of structural competency.

El aporte a la salud pública del Doctor Abraham Horwitz: luces desde la contemporaneidad / A contribuição à saúde pública do Dr Abraham Horwitz: luzes a partir da contemporaneidade / The contribution to public health of Abraham Horwitz: insigths from contemporaneous times

El propósito de este artículo es revisar las ideas centrales del pensamiento del Dr. Abraham Horwitz (1910-2000), quien se dedicó en cuerpo y alma a la salud pública, tanto de Chile como de América Latina y el Caribe. Este trabajo aborda su pensamiento desde una perspectiva contemporánea. Este es justamente nuestro desafío. Aunque vivimos en un mundo diferente al de los años sesenta, con grandes progresos en materia de salud, aún existen enormes brechas entre países y grupos sociales, además de grandes transformaciones sociodemográficas y económicas con alto impacto social.

The purpose of this article is to review the main ideas of doctor Abraham Horwitz’s thinking (1910-2000), who dedicated all his life to public health, both in Chile and Latin America and Caribbean. This paper focuses his thought from a contemporary perspective. This is precisely our challenge. Although we live in a different world from the sixties, with great progress in health, there are still huge gaps between countries and social groups, as well as large demographic and economic transformations with high social impact.

O propósito deste artigo é revisar as ideias centrais do pensamento do Dr. Abraham Horwitz (1910-2000), quem se dedicou corpo e alma à saúde pública, tanto do Chile como da América Latina e do Caribe. Este trabalho aborda o seu pensamento a partir de uma perspectiva contemporânea. Este é justamente o nosso desafio. Embora vivamos num mundo diferente ao dos anos sessenta, com grandes progressos em matéria de saúde, ainda existem enormes diferenças entre países e grupos sociais, além de grandes transformações sociodemográficas e econômicas com alto impacto social.

Allende y la realidad médico-social, a 75 años / Allende and medical social reality: 75 year later

A 75 años de la publicación del libro ‘La Realidad Médico-Social Chilena’, escrito en 1939 por el Dr. Salvador Allende (Presidente de Chile, 1970-73) en su condición de Ministro de Salud del Presidente P. Aguirre Cerda, se re-visita con detalle, parte por parte, los diferentes capítulos de la Salubridad, vistos por el ojo del especialista que luego dirigiese la República, haciendo una breve relación con su vigencia actual. El articulista concluye que el Dr. Allende debió recibir un grado académico honorario en Salud Pública (no existía entonces en el país) y que su análisis, -con las adecuaciones epidemiológicas y políticas del caso-, podría ser el eje de un nuevo Programa de gobierno en el siglo XXI.

75 years later, a re-visiting of the book ‘The medical and social reality of Chile’, finds that it could still be the back-bone of a government policy and plan for the XXI century, given that suitable epidemiological and political upgradings are introduced. The book, written by Dr. Allende in 1939 when he was Minister of Health for President P. Aguirre Cerda, is a thorough and systematic presentation of all factors involved in the diagnosis and planning of health and medical services. The reviewer concludes that Dr. Allende would have deserved an honorary degree in Public Health (none existed at the time in the country).

Between clinical medicine and the laboratory: medical research funding in France from 1945 to the present.

By focusing on funding methods, this paper considers the way in which medical research eventually led to the science-based medicine that is prevalent in France today. This process seems to have taken place in three stages during the second half of the twentieth century. In the 1940s and 1950s, two major events occurred. The first was the creation of a national health insurance fund in France, which opened up new reasons for, and ways of, funding medical research. The second was the development of antibiotics, which triggered a revival of clinical medicine. In the 1960s and 1970s, a proactive government science policy allowed the life sciences and medical research to come together in the wake of a burgeoning new science: molecular biology. Thus, in 1964, the creation of the National Health and Medical Research Institute (Institut national de la santé et de la recherche médicale or INSERM), destined to "molecularize" medical research, was seen as the fulfillment of the government's ambitious research policy. Today, with medicine irreversibly embedded in scientific and technical rationality, health has become a major issue in modern societies. This paper therefore touches on some of the key features of biomedical research, including the revival of funding systems for clinical research and the development of a system of research grants that was made possible by patient organizations and the creation of new funding agencies.

[Social-sanitary situation in Marañón's work in the context of the fight against infectious diseases]. / La cuestión sociosanitaria en la obra de Marañón en el contexto de la lucha contra las enfermedades infecciosas.

Gregorio Marañón y Posadillo (1887-1960), played a leading role in the birth of endocrinology in Spain as is well known. However, his medical work included other important and significant fields. Thus, it was especially in the 1910s and 1920s, when Marañón dealt with the social-sanitary situation in madrid probably due to his professional attachment to the treatment of several infectious diseases and epidemic outbreaks. Actually, since 1911 onwards, he was in charge of the wards of infectious diseases in the Hospital General de Madrid where he had the opportunity of treating an important number of patients suffering from this type of pathology and, as a consequence, in the following years he published several articles in medical journals and presented in the Royal Academy of Medicine in Spain, some reports on infectious diseases and the Spanish health and social conditions at the time. This paper try to analyze this field of Marañón's social and scientific activity.

Socio-political implications of the fight against alcoholism and tuberculosis in Colombia, 1910-1925 / Luchando por la patria, forjando trabajadores: tuberculosis, alcoholismo y salud pública en Colombia, 1910-1925

The emergence of a modern state in Colombia and the centralization of political and administrative power in Bogotá began to take shape during the latter decades of the nineteenth century. The state had a central role within the overarching modernisation discourse that sought to create a common national identity. One of the tasks assigned to the state by the national project was that of implementing policy for regulating public health and strengthening social control institutions. Such objectives should be analyzed as part of larger political centralization processes and the desire to create "ideal" citizens. Public health and sanitary campaigns implemented by government officials during this period targeted vice, immorality, illness and ignorance under the umbrella of social reform programmes. Government officials, hygienists and medical doctors continually placed emphasis on eradicating or regulating alcoholism and tuberculosis from 1910 to 1925, with the hopes of avoiding a national crisis. This paper examines how alcoholism and tuberculosis became central themes in the fears expressed by Colombia's ruling class at the time regarding the broader social decay of the nation. As intellectuals and public officials sought solutions to these ills, their explanations alluded to the disintegration of morality and values and the degenerative effects of vice, addiction and unsanitary conditions.

En Colombia, el surgimiento de un Estado moderno y la centralización del poder político y administrativo en Bogotá comenzaron durante las últimas décadas del Siglo XIX. Dentro de un discurso de modernidad que buscó la consolidación de una identidad nacional, el Estado jugó un importante papel. Dentro de las tareas asignadas al Estado moderno se encontraban políticas de salud pública y control social. Estas políticas deben ser analizadas como parte de una ola centralizadora y la necesidad de forjar ciudadanos sanos. Las campañas de salubridad buscaban erradicar el vicio, la inmoralidad, la enfermedad y la ignorancia bajo el manto de reformas sociales. De 1910 a 1925, médicos, higienistas y políticos se enfocaron en la erradicación del alcoholismo y la tuberculosis, con la intención de evitar una crisis nacional. Este trabajo explora como el alcoholismo y la tuberculosis se convirtieron en temas recurrentes en el discurso medico de principios de siglo, el cual enmarcaba a estas dos enfermedades como símbolos de la decadencia social y moral del pueblo colombiano.

Socio-political implications of the fight against alcoholism and tuberculosis in Colombia, 1910-1925.

The emergence of a modern state in Colombia and the centralization of political and administrative power in Bogotá began to take shape during the latter decades of the nineteenth century. The state had a central role within the overarching modernisation discourse that sought to create a common national identity. One of the tasks assigned to the state by the national project was that of implementing policy for regulating public health and strengthening social control institutions. Such objectives should be analyzed as part of larger political centralization processes and the desire to create "ideal" citizens. Public health and sanitary campaigns implemented by government officials during this period targeted vice, immorality, illness and ignorance under the umbrella of social reform programmes. Government officials, hygienists and medical doctors continually placed emphasis on eradicating or regulating alcoholism and tuberculosis from 1910 to 1925, with the hopes of avoiding a national crisis. This paper examines how alcoholism and tuberculosis became central themes in the fears expressed by Colombia's ruling class at the time regarding the broader social decay of the nation. As intellectuals and public officials sought solutions to these ills, their explanations alluded to the disintegration of morality and values and the degenerative effects of vice, addiction and unsanitary conditions.

Designing HIGH-COST medicine: hospital surveys, health planning, and the paradox of progressive reform.

Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas' hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs.

Uma chama que se apaga: residência de medicina preventiva e social / A failing ligth: preventive and social medical residence

O processo de extinção da residência de Medicina Preventiva e Social (RMPS) constitui um paradoxo diante da necessidade de médicos com especialização em Saúde Coletiva para atuar no Sistema Único de Saúde. O presente artigo realizou uma revisão do processo histórico de construção das RMPS e investigou a estrutura atual dos programas remanescentes a partir da análise dos cenários de prática e das atividades práticas e teóricas desenvolvidas. Ao final foi possível construir uma tipologia em que se identifica o tipo Generalista em Saúde Coletiva, que aborda as três áreas nucleares da Saúde Coletiva; o tipo da Epidemiologia, no qual o foco é exclusivamente essa área; e o tipo da Saúde Comunitária, que se centra na Atenção Primária em Saúde. Do cruzamento do processo histórico de construção com a realidade atual, pode-se inferir que os fatores que têm contribuído para a extinção da RMPS são principalmente a ausência de políticas de Estado para formação na área, bem como o não comprometimento de sujeitos sociais que se relacionam com essa residência, levando à existência de anacrônicas diretrizes orientadoras para formação profissional.

The extinction process of Preventive and Social Medicine Residency Programs (PSMR) have experienced constitutes a paradox in the face of the need for physicists with Collective Health Specialization in the Unified Health System. The present paper investigated which are the practice sceneries and how the practical and theoretical activities are developed into PSMR programs. It was observed that most programs include actions in health assistance, as well as activities in the three main fields of Collective Health. However, significant differences were evidenced among the programs. It was possible construct a typology, identifying the type 'Generalist in Collective Health', who approaches the three main fields of Collective Health; the type 'Epidemiology', which focuses exclusively on this field; and the type 'Community Health', which is centered in Health Basic Care. From the crossing among historical construction process and present reality, it was possibly infer that the inexistent of State Politics to graduate health professionals in this area, and not compromise of involved social subjects with this residence are the most important factors, resulting in the existence of an anachronism in the guidelines.