[In favour of a "new social psychiatry". Current focuses and trends of mental health care dealing between integrative and health economic perspectives]. / Für eine "Neue Sozialpsychiatrie": Aktuelle Brennpunkte und Entwicklungslinien der psychiatrischen Versorgung im Spannungsfeld von integrativen und gesundheitsökonomischen Perspektiven.

Starting from modified sociodemographical, medical, familiar and health economical circumstances it is shown that in different areas of psychiatric supply fundamental offerings are missing or need to be established, thus one has to speak about an undersupply of certain groups (migrants, personality disorders, certain elderly patients). Some of these forward-looking trends and possible prospects in the field of social psychiatry are exemplarily displayed. The thesis is argued and illustrated that the existing social psychiatric institutions require a paradigmatic reorientation, which could be called "New Social psychiatry" and should complement the traditional social psychiatry, which has been orientated to schizophrenic illness, extramural alignment and the rehabilitation purpose of employment up to now.

[Psychosocial and psychosomatic medicine as well as psychotherapy in Switzerland -- developments over the past fifty years]. / Psychosoziale Medizin, Psychosomatik und Psychotherapie in der Schweiz. Entwicklungslinien der letzten 50 Jahre.

The development of psychosocial and psychosomatic medicine in Switzerland is as diverse as the country itself with its four official languages and 26 cantons. Psychosomatic medicine of the past and present can be seen in three phases: Psychogenesis of somatic diseases ( phase 1: from about 1930-1960), bio-psycho-social medicine (phase 2: from 1960-1990) and psychobiology in medicine (phase 3: since 1990). In Switzerland the first phase scarcely noticeable, whereas active development in all fields of psychosomatic medicine and psychotherapy has taken place since 1960. The main tendencies of this development are described. The current situation for patients with psychosomatic and somatopsychic disorders is quite good in the outpatient setting. For inpatient treatment there are only about 400 beds in 19 small departments for the whole country. The strengths of the psychosomatic service system are well-established cooperation of doctors and psychotherapists and only few reactions by health insurance companies. Weaknesses are too few inpatient treatment facilities with long waiting times for patients and a lack of specialized treatment for migrants with psychosomatic disorders. Future prospects are not rosy due to the financial situation in the healthcare system, but neither are they bleak, since patients are emphatically asking for more narrative-based medicine and a partnership-based doctor-patient relationship.

[Psychosocial medicine--a vision needed in medical education and patient care]. / Psychosoziale Medizin--eine notwendige Vision in der medizinischen Ausbildung und Versorgung.

Psychosocial medicine represents the psychosocial aspects in a holistic patient-orientated medicine. It is of great importance in medical education as well as in clinical in- and out-patient treatment. For the near future, further strengthening is necessary in order to prevent the psychosocial aspects from disappearing in medicine. The efficacy and effectiveness of psychosocial therapies need to be further improved.

[Epidemiology, social medicine, environmental medicine--a plea for a difficult but necessary integration]. / Epidemiologie, Sozialmedizin, Umweltmedizin--Plädoyer für eine schwierige, aber notwendige Integration.

The origins of environmental medicine date back more than 2000 years. The increasing incidence of environmental disease together with successful research into their etiology and pathogenesis have caused an impetus for this discipline in quantitative terms. A growing interest of patients, but also of politicians and parts of the industry in actual or suspected environmental risk factors for health have given rise to controversies--rendering the development of a rational, quality-oriented environmental medicine difficult, if not impossible. Given these controversies surrounding environmental health issues formal demarcations between the traditional disciplines (environmental) epidemiology, social medicine, occupational medicine, and environmental medicine become obsolete. Instead, a common agenda with respect to research, quality assurance, risk communication, and prevention as well as patient counselling and policy advising calls for a conceptual and institutional integration of these disciplines.

[Social medicine as a paradigm for innovative developments in public health]. / Sozialmedizin als Paradigma für innovative Entwicklungen im öffentlichen Gesundheitsdienst.

The integration of national health authorities into the regional administrative departments in Bavaria at January 1st 1997 offers the chance to a further, demand-oriented development of the tasks of public health service, according to the situation of requirements of state and communes. Each layer of action educes a separate view on problems. National concern of public health care is above all health protection, medical supervision and the composition of special medical estimates. Public health care developed in communal responsibility first and foremost serves provisions for existence of citizens. Looking after national concerns of public health in a figurative sphere of activity, public health care has ist main focus in the fields of health and social issues (health education and assistance, social-compensatory tasks), prevention and health promotion. Today in research and teaching at universities these tasks are represented by social medicine and the public health research associations. They are elaborating the specialized and the orientation-related knowledge. The public health assistance institutions as well as prevention and health promotion obtaining increasing importance in our health service, developments are necessary that enable the public health service in Bavaria to fulfill these communal tasks in the future.

[Collective health: a "new public health" or field open to new paradigms?]. / Saúde coletiva: uma "nova saúde pública" ou campo aberto a novos paradigmas?

The present essay is an exploratory study of the historical and institutional background of the so-called "crisis in public health", aimed at identifying the new trends and perspectives for the paradigmatic transformation of the health field in the context of the current international panorama of economic and cultural globalization. First, the rhetoric of health is analysed in historical perspective, briefly considering the main elements of the discourse of the ideological movements that historically built the social field of health. Medical Police, Social Medicine and Public Health are included as representative of such movements in 19th century Western Europe. After the Flexnerian turn, these movements were followed by Preventive Medicine, Community Health, Primary Health Care and Health Promotion, which dominated the scene particularly in the second half of the 20th century. The authors also summarise recent concerted PAHO efforts to debate the theory and practice of Public Health in the Americas, vis à vis the emerging demands of the economic, political and social context of Latin American countries. In this regard, the need for a common political agenda is emphasized, with the convergence of three topics-sectorial reform, "Renovation of Health for All" and the "new public health", covering the conceptual, methodological and operative domains. Secondly, a brief systematic account of the conceptual landmarks of the Collective Health movement, as carried through in the two last decades in Latin America, is presented, focusing more particularly on its potential for building up both a domain of transdisciplinary knowledge and a universe of practices. As a field of knowledge, it contributes to the study of health-disease phenomena in populations as a social process, investigating the production and distribution of disease in society as an aspect of social reproduction, and analysing health practices as a labor process integrated into the other social practices. As a universe of practices, Collective Health focuses on its models or action guidelines four objects of intervention: policies (forms of power distribution); practices (behavior modification; culture; institutions; knowledge production; institutional, professional and relational practices); technologies (organization and regulation of productive resources and processes; bodies/environments), and instruments (means of production of interventions). Finally, it is concluded that, although not being in itself a paradigm, Collective Health, as a movement committed to the social transformation of health, presents some possibilities of articulation with new scientific paradigms capable of approaching the health-disease-care object with due regard to its historicity and complexity.

La atención integral en medicina familiar / Total health care in family medicine

En el presente trabajo se revisan algunos antecedentes de la medicina integral en la historia de la medicina mexicana, así como los antecedentes institucionales de la medicina familiar y de la atención integral, para identificar las características que debe tener una atención médica para considerarse integral. Se plantean algunas variables que influyen en la práctica médica y se proponen estrategias para que este proceso pueda ser viable(AU)

La atención integral en medicina familiar / Integral attention in family medicine

En el presente trabajo se revisan algunos antecedentes de la medicina integral en la historia de la medicina mexicana, así como los antecedentes institucionales de la medicina familiar y de la atención integral, para identificar las características que debe tener una atención médica para considerarse integral. Se plantean algunas variables que influyen en la práctica médica y se proponen estrategias para que este proceso pueda ser viable