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(A brief prepared by SOGial uevelopment Division~ Department /"If Gconomic and Social Affairs, :.few Yerk, i'or representatives of the ";;conllmic Commissions i'er Ai'rica, "tsia and the Far Bast, Burepe and La"tin Amerioa, attending the 1967 sessi~n of the ',iRO He6ional C~mmittees)
Distributed to rtcpreEentatives attending the eighteenth sussion 6f the WHO RegioriaJ. Committee for the \iestern Pacii'ic at the request ot the Secretary of ECOOOC.
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The social and eCI'I.'1omic value of good health is an established fact.
What is not so clear is how ttl socially implement the scientific, medical advances which would make goed hAalth possible. 1'he deliberations in both
the Commission for Social Development's 18th session and the 42nd sessien of the Social Cl'lmmi ttee Health si~n 0.;:'
the "::;conomic and 01'1c1al C,\uncil, on the iorld
O~ganization
report on the social questions relating to the exten-
of health services reflect this o')ncern. The report by the \[0rld Heal th Or~aniza ti,.,n
2.
was significant not ('nly
because it represented the first of a series of annual reports to the Commissi0n by the specialized agencies on main issues in the extension of health, education, employment and nutrition, but because the findings, , conclusions· and recommendations. followin b the debate demonstrated that social diagnosis and the 'creation of a social framework for the practice ., of medicine is as important in terras r)f
.
delivery b.nd utilization of gODd
medicine, as are the scientific achievements of llledicine. The problems of social diabmosis apply to all countries, the developed and the developiUb. enonnouslJ complex. 'rhey can be stated simply, but their solutions are For exawple, in one highly dev~loped country (United
states), more children are beaten to death by the';'r parents than die of leukemia; it is known that in many parts of the world, malnutrition would largely disappear if tropical mothers would feed their children with foods readily available; medioal educators agree that there are many elements in a physician's job that can be ;)erformed by non-physicians; and the importance and influenc(3 of social and enVir0!lClental factors on disease and the available and innovative [;lethods of care, are well known. extension of certain infectious ~ld
ihe recrudescence and
communicable diseases, such as the
- 3· venereal d1.seases, trypan.)somiasis, pla5Ue and yellow fever, chclera, bilbarziasis and infe,;.tious hepatitis all reflect problems in social diagnosis and ,'" c.'ntr~L
Social diagnosis and cl'ntrol looms even larger diseases in society, es)ecially the nutriJilld, of course,
.
in the chronic and
C'e~enerat1.ye
tiona1 and deficiency diseases, and the mental disorders.
go'tc:. housin(;lvhi'1h is rat free and vermin free, potable water, clean air and planned cities are all sociai as,ects health serv"ces. relati~
to the extension of
4.
;\n
example of the need to inte6rate the medical armamentarium int. ~roblem
overall social and economic planning of countries is found in the of malaria era<iicati.1n in Africa.
It is well kl1.own that malaria exacts absent~ism.
a tremendous social ru1d economic t,oll in death, ill-health, and
Indeed, in l\fi;seria ab113 there ar'3 at least 50,()OO deaths per year in children under five years of age. !<evertheless, as many as sixteQlnfrican
ceuntries are not partici1)ating in any malaria eradication pro6I'amma at all. In order to .;ct such pro,;Ia.;.l1Iler "'tarted, it may be necessary as a
first step to abanrlon the secto:;:oa.l approach to health plannin,; and budgeting and instead attempt to integrate health plans into the overall economic and social development plans of countries.
5.
An analysis of the nineteen findings, conclusions and recommendations
made by the Ccmrnission for B0cial Deve10pment, reveal f<mr major categories of social diabnostic and social thera.)eutic concern: is concerned with basic assumptions of health planne~s
(1) J?lanning which as they determine
tar;ets an1 set priorities; (2) the relationship between socia-oultural factors and health; (3) the collection of socio-cultrual data bearing on health, illness and the utilization of services; and (4) the relationships betlveen health services and other social services.
~.
4 --
(1)
Pliillning.
The conce:cn here is to t",ke the next steps
made possible by the achievements 0f the Uorld Health f:.rganizution Expert Committee which reported on "National Health PJanning in Developing Countries," (Ind. Hlth. Org. Techn. i1:ep. Ser·, ~ 1967, 350). Here one would want to
examine the en"(;ire relationship betveen the exigencies and demands of socic--poli tical structure and. the basic assumptions of health planners as they determine targets "
and set pri',rities.
'.Ihat is rec.uired is not only more and
better stc.tistics, but an analysis of the entire o.evelopmental frame of refe:cence whi_ch determines both the options and the directions in the health sector in relation to overall planning, and which wav at times result paradoxically in overplanning in relationship to the social and economic
(2)
The relationship be1;17e~s02J-o-cul tural factors and health. The concei."l'l here in the broadest sense is betueen the cultural behaviour of peoples anCi. how this relates to health behaviour and health innovationso Such an approach to the problems and
proe;ralllllles of social medicine would ra11t;'e all the way from consideration of the variable utilization of health services, acceptance and rejection of health programmes, to uses of indi6'enous folk healers.
(3)
Collection of socia-cultural data of use to social medicine. The oonoern here is with an organized, systematic approach to the collection of soci~-cultural
data that bear on health,
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illness, and the utilization of services. informc~ tion
Such cultural
about dietary habits, child rearing practices,
social values and attitudes bearing on fertility, sanitation and the like, could all make a contribution not only to epideciO:'ogy concerning the different incidences of ciiseases by ethnicity and class, but could also contribute to action progrrurunes of health planners as they seek to focus on the needs of target populations.
(4) rtelationships between health services and other racial services. Here one is concerned with the en~ire
spec,rum of those health
and social services which affect the levels cf living of peoples. Health is not only affected by the availability and utilization vf hospitals and clinics, but by the availability and utilizati0n of all the social defence and welfare services. In that
sense, the \;0rld :{e8.lth Or"';'-iXliz8.ti<.n definition of health as Ita state of complete physical, wental and social well-being and n@t merely the a"osence of disease ()'C
infirmi tyll embraces The links
all the welfare syster;ls into the health system.
between these various systeT'lS are important in orlier to unde~stand
and effectively deal with such
pr~blems
as disability,
mental illness and family planning.