Conceptualization and teaching health advocacy in undergraduate medical education: a document analysis.

BACKGROUND: Health advocacy is considered to be a core competence for physicians, but it remains unclear how the health advocacy role, despite being described in overarching competency frameworks, is operationalized in undergraduate medical education (UME). This study aimed to identify how health advocacy is conceptualized and taught in undergraduate medical curricula. METHODS: We performed a qualitative analysis of curriculum documents from all eight medical schools in the Netherlands, all of which offered competency-based UME. Thematic analysis was used to code all the documents and generate themes on health advocacy conceptualization and teaching. To categorize the emerging themes, we used the framework of Van Melle et al. for evaluating the implementation of competency-based medical educational programs. RESULTS: Health advocacy was mostly conceptualized in mission statements about social responsibility of future physicians, related to prevention and promoting health. We found key concepts of health advocacy to be taught mainly in public health and social medicine courses in the bachelor stage and in community-based clerkships in the master stage. Specific knowledge, skills and attitudes related to health advocacy were taught mostly in distinct longitudinal learning pathways in three curricula. CONCLUSION: Health advocacy is conceptualized mostly as related to social responsibility for future physicians. Its teaching is mostly embedded in public health and social medicine courses and community-based settings. A wider implementation is warranted, extending its teaching to the full width of medical teaching, with longitudinal learning pathways providing a promising route for more integrative health advocacy teaching.

Making A Difference: Launching a Multimodal, Resident-Run Social Emergency Medicine Program.

Introduction: Social medicine seeks to incorporate patients' social contexts into their medical care. Emergency physicians are uniquely positioned to address social determinants of health (SDoH) on the frontlines of the healthcare system. Miami-Dade County (MDC) is a diverse and socially vulnerable area. In 2020, the University of Miami-Jackson Health System (UM-JHS) emergency medicine (EM) residency program launched a multimodal, resident-led Social EM program to identify and address SDoH in the emergency department (ED). Methods: We use a four-pillar approach to SDoH in the ED: Curriculum Integration; Community Outreach; Access to Care; and Social Justice. Residents graduate with a knowledge of Social EM principles through an 18-month curriculum, an elective, and a longitudinal track. We developed sustainable initiatives through interdepartmental and community-based partnerships, including a Narcan distribution initiative, an ED-based program linking uninsured patients to follow-up care, a human trafficking education initiative, and a quality improvement initiative for incarcerated patients. Results: Given that the 18-month curriculum was launched in 2022, a full rotation of the curriculum had not been completed as of this writing, and data collection and analysis is an ongoing process. The initial pretest and post-test survey data show improvement in knowledge and confidence in managing Social EM topics. The Narcan initiative has screened 1,188 patients, of whom 144 have received Narcan. The ED-based patient navigation program has enrolled 31 patients to date, 18 of whom obtained outpatient care. Analysis of the impact/effectiveness of the program's other initiatives is ongoing. Conclusion: To our knowledge, this is one of the most robust social EM programs to date, as many other programs primarily focus on service opportunities. Rooted in the revised principles of Bloom's taxonomy of cognitive learning, this program moves beyond understanding Social EM tenets to generating solutions to address SDoH in and outside the ED.

The Power of Partnership Beyond Social Prescribing.

This commentary focuses on the social determinants of health and how they may be more fully integrated into engagement-capable environments. In this commentary, the authors provide excerpts from their in-depth discussion that explored how the foundational principles of the Gattuso Centre for Social Medicine emphasize the importance of prioritizing care for populations that are marginalized and engaging communities to improve health outcomes. The article delves into some of the historic and current issues facing communities and individuals that are marginalized and describes how a large academic centre has leveraged its structures and resources to build partnerships with communities and community organizations to address these challenges.

A Saúde Coletiva na Amazônia: redes de pesquisa, formação e situações de saúde e condições de vida / Collective Health in the Amazon: research networks, training and health situations and living conditions

O livro faz parte do projeto Programa Nacional de Cooperação Acadêmica na Amazônia (PROCAD Amazônia/CAPES) que envolve três instituições: Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia (PPGVIDA) do Instituto Leônidas e Maria Deane/Fiocruz; Programa de Pós-Graduação em Saúde Coletiva da Faculdade de Ciências da Saúde da Universidade de Brasília (UnB); Programa de Pós-Graduação em Saúde Pública da Universidade de São Paulo (FSP USP). A coletânea traz contribuições de docentes e discentes que atuam na Amazônia, mostrando a potencialidade dos territórios e as estratégias de tecnologias de cuidado dos povos originários. A obra também traz resultados de pesquisa dos principais agravos da região, trazendo reflexões para o aprimoramento das políticas públicas. Por fim, a obra contribui para a ampliação da produção do conhecimento na saúde coletiva na Amazônia, mostrando que as parcerias institucionais e de grupos de pesquisa potencializam a ciência e as redes de atenção na região.

RISE-EM: Resident Instruction in Social Emergency Medicine, a Cohort Study of a Novel Curriculum.

There is recognition in the field of emergency medicine (EM) that social determinants of health (SDoH) are key drivers of patient care outcomes. Leaders in EM are calling for curricula integrating SDoH assessment and intervention, public health, and multidisciplinary approaches to EM care throughout medical school and residency. This intersection of SDoH and the emergency care system is known as social emergency medicine (SEM). Currently, there are few resources available for EM training programs to integrate this content; as a result, few EM trainees receive adequate education in SEM. To address this gap, we developed a four-part training in SEM tailored to EM residency programs and medical schools. This curriculum, known as RISE-EM (Resident Instruction in Social Emergency Medicine), uses video lectures, case examples, and group discussions to engage trainees and develop competency in providing sound care that is grounded in evidence-based principles of SEM. In the current study, we tested RISE-EM by delivering the video lectures to residents and medical students in two training programs. We administered pre- and post-course knowledge tests and a post-course participant attitudes survey to assess the acceptability and potential efficacy of the program for improving SEM knowledge and attitudes among EM learners. We found it to be both feasible and acceptable to introduce SEM content in residency conferences, with preliminary data showing statistically significant improvement in knowledge of the content and self-efficacy to apply it to their clinical practice. In summary, RISE-EM has been highly valued by EM learners and viewed as a strong supplement to their existing training, and it has been shown to successfully improve SEM knowledge and attitudes.

Jaime Breilh na UNIFESP: saúde dos povos e o pensamento metacrítico / Jaime Breilh at UNIFESP: peoples' health and metacritical thinking

A conferência de Jaime Breilh em maio de 2021 foi um encontro potencializador do caminho de resistência percorrido pelo Eixo de Trabalho e Saúde do Instituto de Saúde e Sociedade do campus da Baixada Santista da Unifesp, em meio à pandemia de Covid 19 e a um governo negacionista de extrema direita no Brasil. A afirmação de seus valores éticos e políticos nutriu essa produção coletiva que divulga e homenageia a qualidade científica e sobretudo humana de Breilh. Como música muito bem orquestrada, ressalta-se na composição do livro a excelente capacidade técnica e afetiva das organizadoras (Dina Czeresnia).

Entrelaçando arte, cultura e saúde: possibilidades de coracionar o cuidado com a vida / Interweaving art, culture and health: possibilities for coloring care for life

Esta obra representa a colheita da experiência vivida no nordeste do Brasil envolvendo, mais especificamente, os estados do Ceará e do Rio Grande do Norte, provocados por um processo formativo de Especialização e Aperfeiçoamento em Educação Popular e Promoção de Territórios Saudáveis na Convivência com o Semiárido realizado entre os anos de 2018 e 2019. Os autores e as autoras apresentam reflexões extraídas dos trabalhos de conclusão de curso, trazendo em sua escrita, uma rica produção de conhecimento que emergiu de experiências existentes nos territórios e movimentos aos quais pertencem. Traz a originalidade de revelar e referendar sujeitos populares se reconhecendo autores e sujeitos sociais da produção de conhecimento, protagonizando o movimento de uma autoralidade coletiva. Revela, ainda, aprendizados que referenciam os princípios da educação popular com saberes que se produzem de modo sentipensante como já provocava Fals Borda. A originalidade também se presentifica na expressiva produção acerca da arte como espaço, modo, caminho de produção de conhecimento, de fortalecimento da participação popular e comunitária e como abordagem pedagógica problematizadora, crítico- reflexiva e criativa. A arte aqui compreendida como linguagem natural do humano (Ostrower, 1977) e como espaço de educabilidade que articula o mundo vivido (Linhares, 2003; Dantas, 2020), em suas multidimensionalidades se coloca em diálogo com os processos de cuidado e desponta, também, como modo de produção de conhecimentos, articulando experiências coletivas sem descuidar das subjetividades e vai se desvelando também como cuidado. Ao entrelaçar os temas da arte, cultura e saúde os escritos deste volume nos convidam a coracionar o cuidado com a vida. Aqui referenciamos Guerrero Arias (2010) que fala do coracionar, como possibilidade de recuperar a importância da sensibilidade, a afetividade nos processos de produção de conhecimento. Este volume se organiza considerando temas que se entrelaçam mas necessitam de um olhar cuidadoso para as singularidades que trazem em suas essências. Desse modo, esta obra tem duas Seções, a saber:"A Arte e sua Multidimensionalidade: coracionando o cuidado com a vida" na seção I e "Cultura e Cuidado: diálogos, afetos e reflexões" na seção II. Esperamos que as reflexões aqui produzidas sejam fertilizadoras de novos aprendizados e possam ser provocativas de outras possibilidades de construção compartilhada de conhecimentos que gerem rebeldias necessárias e apontem inéditos viáveis para a produção de conhecimentos que rompam com as colonialidades, produzam novas e profícuas autoralidades ancoradas na solidariedade e na cooperação.

At the deep end: towards a social emergency medicine.

People experiencing the highest levels of social deprivation are more likely to present to emergency care across the spectrum of disease severity, and to have worse outcomes following acute illness. Emergency medicine in the UK and Europe has lagged behind other regions in incorporating social emergency medicine into practice. There is evidence that emergency clinicians have the potential to mitigate health inequalities, through advocacy and intervention supported by high-quality research, while also acknowledging the limitations intrinsic to the environment in which they work.

La medicina social y las ciencias sociales en América Latina: tensiones conceptuales para la transformación de la salud pública en el siglo XX

[RESUMEN]. El desarrollo de la salud pública en América Latina durante el siglo XX combinó, desde el principio, el marco de la medicina social sobre los orígenes sociales, políticos y ambientales de la enfermedad con los aportes del trabajo de campo de la antropología médica. A pesar de la hegemonía del modelo médico, el surgimiento del marco de la medicina preventiva legitimó aún más la participación de los científicos sociales en el estudio de la multicausalidad de la enfermedad. Sin embargo, las limitaciones que trajo consigo la falta de contextualización histórica y política del modelo de la medicina preventiva dieron paso al movimiento latinoamericano de medicina social, basado en el materialismo histórico, y al desarrollo tanto de la epidemiología crítica como de la antropología médica crítica.

[ABSTRACT]. The development of public health in Latin America during the 20th century combined, early on, the social medicine framework on the social, political, and environmental origins of disease with the contributions of medical anthropological fieldwork. Despite the hegemony of the medical model, the surge of the preventive medicine framework further legitimized the involvement of social scientists in the study of the multicausality of disease. However, the limitations brought by the preventive medicine model’s lack of historical and political contextualization gave way to the Latin American social medicine movement, which was grounded in historical materialism, and the development of both critical epidemiology and critical medical anthropology.

[RESUMO]. Desde o início, a evolução da saúde pública na América Latina ao longo do século XX combinou o marco teórico da medicina social sobre as origens sociais, políticas e ambientais das doenças com as contribuições derivadas do trabalho de campo da antropologia médica. Apesar da hegemonia do modelo médico, o surgimento do modelo de medicina preventiva legitimou ainda mais a participação dos cientistas sociais no estudo da multicausalidade das doenças. Entretanto, as limitações causadas pela falta de contextualização histórica e política do modelo de medicina preventiva abriram espaço para o movimento latino-americano de medicina social, fundamentado no materialismo histórico, e para o desenvolvimento da epidemiologia crítica e da antropologia médica crítica.

Storylines of family medicine II: foundational building blocks-context, community and health.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'II: foundational building blocks-context, community and health', authors address the following themes: 'Context-grounding family medicine in time, place and being', 'Recentring community', 'Community-oriented primary care', 'Embeddedness in practice', 'The meaning of health', 'Disease, illness and sickness-core concepts', 'The biopsychosocial model', 'The biopsychosocial approach' and 'Family medicine as social medicine.' May readers grasp new implications for medical education and practice in these essays.

ESDM intervention in severe preschool autism: an Italian Case report, psychological and social medicine reflections.

BACKGROUND: The goal of our contribution is to discuss a preschool intervention based on the Early Start Denver Model and the use of the main tools for the detection of adaptive behaviour in cases of autism: Vineland, ABAS. CASE PRESENTATION: the work is the presentation of a clinical case that has benefited from an intervention with the Early Start Denver Model methodology for the benefit of a child with socio-cultural and economic disadvantages. This early intervention, in a child of 36 months, which followed the diagnosis, was possible thanks to the intervention of many third-sector organizations which allowed this child, with a serious autism profile, to receive an evidence-based intervention for free. At the beginning of the intervention, the child presented a diagnosis of severe autism with absence of gaze, vocalizations and other communicative impairments. The level of motor clumsiness was also quite high, as were stereotypies. CONCLUSIONS: Research has shown the usefulness of intervening in this area with an early assessment and/or diagnosis and immediate intervention; however, public health services are not always able to maintain this pace. Our contribution therefore shows on the one hand the evidence of the improvements achieved by the child despite the low intensity of the treatment, and on the other hand, demonstrates the total versatility and adaptability of the Denver Model to the Italian context. In our conclusions, there are also some reflections on the tools used to measure adaptive behavior which seem to have a number of limitations and criticalities.

[Additional qualification "Social medicine" for physicians]. / Zusatzbezeichnung "Sozialmedizin" für Ärztinnen und Ärzte.

Social medicine is the medical field that specializes in relationships between health, disease, and society. The goal of social medical care should be to enable functioning and participation in all areas of life as much as possible. Social medicine can be understood as a bridge between individual health care and public health and to other medical specialties. Expertise in social medicine is also helpful for dermatology and in daily clinical practice. This article presents the specialization "social medicine" in Germany.

[Role of social medicine within the German Federal Employment Agency]. / Aufgabe des Arztes in der Sozialmedizin am Beispiel der Bundesagentur für Arbeit.

Social medicine deals with the interrelationships between health and society-as a cross-sectional subject within medicine and a bridging subject at the interfaces to other specialist disciplines. In the public and within the health system, social medicine still does not receive the attention it should be given, despite to its medical and socioeconomic importance. A significant proportion of social medicine specialists in Germany work as experts for social security providers. Using the example of the Medical Specialist Service ("Ärztlichen Dienstes", ÄD) of the German Federal Employment Agency ("Bundesagentur für Arbeit", BA), the medical tasks in social medicine are outlined. About 350 full-time medical employees nationwide as well as other contracted physicians support the specialists of the employment agencies and job centers to integrate those seeking training, jobs and employees with health restrictions into the labor market or maintaining an existing integration. In each individual case, they assess the extent of the health restrictions, the performance/earning ability, the suitability for training and professions as well as the requirement and type of vocational rehabilitation services. The ÄD's approximately 500,000 expert opinions each year are not only of far-reaching importance for the BA's affected customers, but also contribute to the responsible, effective, and accurate use of social system resources.

Structural competency in global perspective.

This special issue aims to help fill two critical gaps in the growing literature as well as in practice. First, to bring together scholars and practitioners from around the world who develop, practice, review, and question structural competency with the aim of promoting a dialogue with related approaches, such as Latin American Social Medicine, Collective Health, and others, which have been key in diverse geographical and social settings. Second, to contribute to expanding structural competency beyond clinical medicine to include other health-related areas such as social work, global health, public health practice, epidemiological research, health policy, community organisation and beyond. This conceptual expansion is currently taking place in structural competency, and we hope that this volume will help to raise awareness and reinforce what is already happening. In sum, this collection of articles puts structural competency more rigorously and actively in conversation with different geographic, political, social, and professional contexts worldwide. We hope this conversation sparks further development in scholarly, political and community movements for social and health justice.

[Manfred Pflanz (1923-1980) - A key Protagonist for the Institutionalization of Social Medicine and Medical Sociology in Germany]. / Manfred Pflanz (1923­1980) ­ zentraler Akteur bei der Institutionalisierung von Sozialmedizin und Medizinsoziologie.

Manfred Pflanz, an internist with his focus on social medicine, medical sociology and epidemiology, (1923-1980) played a key role in the institutional integration of social science expertise into medicine in the Federal Republic of Germany during the 1960s and 70 s. The present study, a biographic sketch of Pflanz, describes his work, his programmatic ideas on social medicine and medical sociology, and his activities as an expert consultant in public health for various political entities. This should enable getting an insight into the origins and ramifications, as well as the contemporary programs and international embeddedness of the overlapping fields of social medicine and medical sociology in Germany.

Global translation and adaptation of social medicines and structural competencies.

This commentary on the special issue of Global Public Health on structural competency in global perspective asks: what is specific to the U.S. about structural competency, and what is its utility beyond the U.S., especially in the 'global south'? Why are biomedical practitioners the focus of U.S. structural competency? And what can U.S. structural competency advocates learn from the deep and rich social medicine traditions of Latin America? And is there anything that Latin American and other non-U.S. social medicine traditions might learn from U.S. structural competency? The commentary identifies the crucial insights from international comparisons include that racial justice movements are Social Medicine innovators in the U.S., that cultivating allies within biomedicine can enhance the impact of community health movements, and that cross-fertilising U.S. Structural Competency and social medicine traditions across regions should be a priority for the fields.

Latin America at the margins? Implications of the geographic and epistemic narrowing of 'global' health.

To explore the narrowing of the concept of 'global' in global health, this article traces how Latin America has held a place of both privilege and power as well as marginalisation in the field. We employ a modified extended case method to examine how Latin America has been 'seen' and 'heard' in understandings of global health, underscoring the region's shifting role as a key site for research and practice in 'tropical medicine' from the mid-nineteenth century through World War II, to a major player and recipient of development assistance throughout the 'international health' era after World War II until the late twentieth century, to a region progressively marginalised within 'global health' since the mid-1980s/1990s. We argue that the progressive marginalisation of Latin America and Southern theory has not only hurt health equity and services, but also demonstrates the fundamental flaws in contemporary 'global' thinking. The narrowing of global health constitutes coloniality of power, with Northern institutions largely defining priority regions and epistemic approaches to health globally, thus impoverishing the field from the intellectual resources, political experience, and wisdom of Latin America's long traditions of social medicine and collective health.

Germinal Rodríguez: salud pública, política y divulgación sanitaria en primera persona, Argentina, 1922-1960 / Germinal Rodríguez: public health, politics and medical popularization in the first person, Argentina, 1922-1960

Resumen Este trabajo reconstruye la trayectoria del médico argentino Germinal Rodríguez en diálogo con la historia social de la salud y la enfermedad y con una reciente corriente historiográfica de biografías médicas. En base a una metodología cualitativa de análisis documental, analizamos expedientes oficiales de la Universidad de Buenos Aires, fuentes periodísticas, libros de Rodríguez y otras fuentes secundarias. Como resultado, podemos afirmar que su vida profesional estuvo marcada por la enseñanza universitaria y una exitosa carrera académica, así como por su intensa militancia socialista entre 1920-1930. Rodríguez fue también un divulgador, un experto de consulta en políticas públicas para su partido y funcionario estatal en los años del peronismo.

Abstract This article examines the career of Argentine doctor Germinal Rodríguez, situating it within the context of social history of medicine and the recent trend of medical biographies. Using a qualitative documentary analysis methodology, we analyzed various sources, including official records from the University of Buenos Aires, journalistic articles, and books by Rodríguez himself. Our analysis reveals that Rodríguez's enjoyed a successful academic career in university teaching, while concurrently engaging in active socialist activism between 1920-1930. Beyond academia, Rodríguez served as a science popularizer, a policy consultant for his party, and even a public official during the Peronist era.