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1、Unit SevenWhat is Social Medicine?Do you believe?Beforewebegin,answerthese3questions:1.Shoulddoctorsfeelacompellingdutytohelpthehugenumbersofpeoplewhosufferdiseasescausedbypoverty,malnutrition,andalackofeducation?2.Whetherornotyoucoulddoit,doyouadmiredoctorswhomakehelpingthepoortheirlifeswork?3.Doyo
2、uthinkadoctorshouldbecomeinvolvedinpoliticstohelphispatients?(Doyoufeelthatadoctormayneedtoleavemedicineforpoliticsundercertainconditions?)The 3 Authors of this articlebelievetheanswerstothese3questionsare:“yes,yes,&yes”.Theythemselveshavededicatedtheirprofessionallivestoservingthepoor.Andthroughout
3、thearticle,youseehowdeeplytheyadmiredoctorswhobothservethepoorandworkforpoliticalreform.One last question,.canyouthinkofanyexamplesofdoctorswhoseconcernforthewelfareofthepeopleturnedthemintopoliticaladvocates?Canyounamepeoplewhoweretrainedtousemedicinetohealsickindividualsbutturnedtopoliticstohealso
4、ciety?From Dr.to AdvocateDr.Jiang Yanyong(b.October4,1931)theBeijingdoctorwhopublicizedthepoliticallymotivatedunder-reportingoftheSARSepidemicinChina.From Dr.to Political ReformerErnesto“Che”GuevaraLead-in questions1.Whatissociology?Whatismedicine?Doyouknowanythingaboutsocialmedicine?2.Whydoweneedto
5、lookatthesocialfactorsrelatedtothepatients?3.Whichaspectofsocialmedicineareyoumostinterestedin?4.Canyoulistsomeimportantfiguresinsocialmedicine?A Closer Look(Paragraph1isthestylisticstartbutitdoesnotseemtobethemainthesisorunifyingparagraphinthisarticle.)Itsays,HealthcareintheU.S.isamess.Bigbusiness-
6、insuranceandpharmacycompanies-havetakenover.Patientsarepayingmoremoneynowforhealthcare,andgettinglessandlesstoshowforitpooreroutcomesthaninmanyothercountries.Paragraphs 2,3,&4containtherealthesis(paragraph2),definingcharacteristicsofsocialmedicine(3),andthepresentationplanfortherestofthepaper(4).Par
7、aphrasingParagraph2:ButbigbusinesshasntcompletelykilledMedicineintheU.S.Thereishope.Itcomesfromahistoryofprogressiveactivism.Inthe1800s,thatactivismledto“thesystematic study of the relationship between society,disease,and medicine”Thatssocialmedicine-evenifexactdefinitionsvary.3Alldefinitionsofsocia
8、lmedicinepointto3centralcharacteristicsorbeliefs:1.Socialandeconomicconditionseffecthealth,disease,andmedicalpractice.2.Societyhasadutytofocusonpublichealth.3.Societymustpromotehealththroughbothindividualeffortsandpublic/governmentefforts.4:The PlanA.DiscussoriginsofsocialmedicineinEurope,andB.itssp
9、readtotheU.S.&LatinAmerica.C.Then,howcanthisexampleofprogressiveactivismhelpusdealwiththeproblemsofmodernhealthissuesandhealthcare.Rudolf Ludwig Karl Virchowfiro,viro(*13.Oktober1821inSchivelbein,Pommern;5.September1902inBerlin)DieMedizinisteinesozialeWissenschaft,unddiePolitikistnichtsweiteralsMedi
10、zinimGroen.“VirchowbeteiligtesichanderMrzrevolution1848.Part II(Paras4-8)How Social and Economic Part II(Paras4-8)How Social and Economic Conditions Impact Health and DiseaseConditions Impact Health and Disease1.Rudolph Carl Virchow(13October18215September1902)oneofthefoundersofsocialmedicine;thefat
11、herofmodernpathology“Report on Typhus Epidemic in Upper Silesia”oneoftheneglectedclassicsofsocialmedicineatermhedidmuchtopopularize.Hisanalysisoftheepidemicemphasizedtheeconomic,social,andculturalfactorsinvolvedinitsetiology,andclearlyidentifiedthecontradictorysocialforcesthatpreventedanysimplesolut
12、ion.Insteadofrecommendingmedicalchanges(i.e.,moredoctorsorhospitals),heoutlinedarevolutionaryprogramofsocialreconstruction;includingfullemployment,higherwages,theestablishmentofagriculturalcooperatives,universaleducation,andthedisestablishmentoftheCatholicChurch.conceptof“artificialepidemics”arising
13、inperiodsofsocialdisruption.Drawing comparisons with 2.thestruggleagainstAIDStoillustrateVirchowsconceptof“artificialepidemicsnotonlyisitafightagainstaninfectiousdiseasebutitsalsoastrugglefortherightsofwomen,children,sexworkers,andsexualminorities-astruggletodeliverclinicalcaretosomeoftheworldspoore
14、stpeople.Genericmedicationshopetohelpmillionsversustherightsofpharmaceuticalcorporationstotheir“intellectualproperty”whichtrumpspublichealth.3.organizedmedicinehastraditionallybeenslowtoacceptthefactthatsocialfactorsplayanimportantroleindisease.4.earlyinspirationofsocialmedicinecamefromEuropeanhealt
15、hstatisticsHealthanddiseasewerecorrelatedrespectivelywithwealthandpoverty.Unfortunately,thisremainstruetodayandhealthinequalitiesareanactiveareaofresearchandactivism.Dr.Thomas Dr.Thomas HodgkinHodgkin(17981866)consideredoneofthemostprominentpathologistsofhistimeandapioneerinpreventivemedicine.Heisno
16、wbestknownforthefirstaccountofHodgkinsdisease,aformoflymphomaandblooddisease,in1832.Hodgkinsworkmarkedthebeginningoftimeswhenapathologistwasactively involved in the clinical process.(Henry)Norman(Henry)Norman BethuneBethune(March 4,1890 November 12,1939;Chinese:白求恩;pinyin:Bi Qin)Rememberedforhisserv
17、iceasafrontlinesurgeonsupportingtheRepublicangovernmentduringtheSpanish Civil War andforhisservicewiththeCommunistEighthRouteArmy(BaLuJun)duringtheSecondSino-JapaneseWar.Dr.BethuneeffectivelybroughtmodernmedicinetoruralChinaandfrequentlytreatedsickvillagersjustasoftenaswoundedsoldiers.Awell-regarded
18、socialistandWWIveteran,hewrotethatwarsweremotivatedbyprofits,notprinciples.“The last time I checked my medical textbooks,the specific therapy for malnutrition was,in fact,food.”-Dr.H.Jack Geiger,1965GeigerhasbeenpartofhumanrightsmissionsforPHR,theUN,andtheAAAStoformerYugoslavia,IraqandKurdistan,theW
19、estBankandGazaStrip,andSouthAfrica.Mostofhisprofessionalcareerhasbeenfocusedontherelatedissuesofhealth,poverty,andcivilrights.Hestartedthefirst2communityhealthcentersintheU.S.Thesecentersbecamemodelsforthenationalnetworkofmorethan1100CHCsservingsome20millionlow-incomeandminoritypatients.Part III(Par
20、as9-10)The Health of the Population is Part III(Paras9-10)The Health of the Population is a Matter of Social Concerna Matter of Social ConcernManysawthesedisparitiesasacallforsocialreformorrevolution.ThomasHodgkinNormanBethuneDuringthetwentiethcenturyLatinAmericadevelopedoneofthemostactivecentersofs
21、ocialmedicine.SalvadorAllendeCheGuevaraitemphasizespraxis:developingacloserelationshipbetweentheoryandpractice.Part IV(Paras11-15)Society Should Promote Health Part IV(Paras11-15)Society Should Promote Health through Both Individual and Social Meansthrough Both Individual and Social Means1.Socially-
22、mindedphysiciansbegantolookforwaysinwhichtheirclinicalpracticemightreflectdifferentsocialvalues.Ifpoliticsismedicinewritlarge,itisalsoapparentthatmedicineispoliticswritsmall.(“MedicineisaSOCIALscienceandPoliticsisnothingmorethanMedicineonalargerscale.”PoliticswasanaturaloutgrowthofVorchowsconcernfor
23、thepeople.HetookpartintheMarch1848RevolutionandlaterfoundedtheGermanProgressiveParty.)Thewayinwhichclinicalcareisprovidedhasimportantpoliticalramifications.2.Asaresult,thecommunity-orientedprimarycaremodelincorporatedinnovationsbasedonsocialmedicineprinciples.Clinicalcarewastheresponsibilityofateamc
24、omposedofaprimarycaredoctor,acommunitynurse,andahealtheducator(typicallysomeonedrawnfromthecommunity).Thehealthteam,unlikethetraditionalfamilydoctor,wouldsystematicallyconsidertheimplicationsofthebroadersocialcontextforindividualpatientsandthepossibleepidemiologicalimplicationsofnewdiagnosesintheiri
25、ndividualpatients.3.ManyoftheidealsofthecommunityhealthmovementwereembodiedintheDeclarationofAlma-AtaissuedbytheWorldHealthOrganizations1978InternationalConferenceonPrimaryCare.ItreaffirmedtheWHOsholisticdefinitionofhealth.The“existinggrossinequalityinhealth”wasunacceptable.Peoplehavetherighttoparti
26、cipateintheorganizationandimplementationofhealthcare.Primarycareshouldbeuniversallyavailable.Part V(Paras16-19)Is Social Medicine Relevant to Part V(Paras16-19)Is Social Medicine Relevant to Medical Practice Today?Medical Practice Today?1.Twodecadesof“marketreform”inU.S.healthcarehavenotgivenallAmer
27、icansaffordable,qualityhealthcarenorisitlikelytodoso.Theessenceofthe problem is a political one.(Health care is a political problem.)2.Cliniciansknowthelivesoftheirpatientsintimatelyandthusareuniquelysuitedtounderstandthepoliticalandsocialdimensionsoftheirpatientsproblems.(Doctors must use their spe
28、cial insight to advocate for the political reform of health care.)3.ThelogicalanswertothequestionastohowconditionssimilartothoseunfoldedbeforeoureyesinUpperSilesiacanbepreventedinthefutureis,therefore,veryeasyandsimple:education,withitsdaughterslibertyandprosperity.(Stop future health tragedies by s
29、preading knowledge,freedom,and economic security).DoctorswithoutBordersInternationalPhysiciansforthePreventionofNuclearWarConcern for Care can lead to political advocacyInternationalPhysiciansforthePreventionofNuclearWarortoanattempttodelivercarewithoutovertlytakinganysidebutthepatients.Medicinssans
30、Frontiers.Discussion and Presentation:Discuss the following topics with your partner or group members.Then present your conclusions in your group or class.1.CompareSocialMedicinewithclinicalmedicine.2.DoyouagreewithEisenbergsnotionthat“Allmedicineisinescapablysocialmedicine”?3.Whatdoyouthinkofthenew
31、definitionofhealthbyWHOin1948:“Healthisastateofcompletephysical,mentalandsocialwell-beingandnotmerelytheabsenceofdiseaseorinfirmity.”4.Discussthedevelopmentofsocialmedicineindifferentcountries,especiallyinChina.5.Whatconsequenceswillsocialmedicinebringus?6.Whyissocialmedicinenecessaryandimportantfor
32、medicalstudents?Supplementary Word StudyPara1disguise disaizn.1.anoutwardsemblancethatmisrepresentsthetruenatureofsomethingThetheatricalnotionofdisguiseisalwaysassociatedwithcatastropheinhisstories.2.anyattirethatmodifiestheappearanceinordertoconcealthewearersidentity3.theactofconcealingtheidentityo
33、fsomethingbymodifyingitsappearanceHeisamasterofdisguise.v.-makeunrecognizableTheherbdisguisesthegarlictaste.Wedisguisedourfacesbeforegoingtotheparty.Para2in earnest adv.-inaseriousmannerInjustthethreeyearssinceresearchersstartedlookingin earnest,theyhavefoundhundredsofmicroRNAsmorethan150inhumansalo
34、ne.take on v.承担；呈现；具有；流行；接纳；雇用；穿上;挑战 assume1.takeonacertainform,attribute,oraspectThecampushastaken on anewlook.校园换了新貌。Theoldtermhastaken on anewmeaning.这个旧词有了新的含义。2.takeontitles,offices,duties,responsibilities3.acceptasachallenge4.admitintoagrouporcommunity5.contendagainstanopponentinasport,game,or
35、battlePara3shed light on-v.makefreefromconfusionorambiguity;makeclear阐明；使清楚地显出Theauthorsbelievetheirresearchcouldalsoshedlightonhowhumanslearntospeak.Para4disruption disrpnn.1.anactofdelayingorinterruptingthecontinuity2.adisorderlyoutburstortumult3.aneventthatresultsinadisplacementordiscontinuity4.t
36、heactofcausingdisorderPara6outrage autreidn.1.afeelingofrighteousanger2.awantonlycruelact3.adisgracefulevent4.theactofscandalizingv.1.strikewithdisgustorrevulsion2.violatethesacredcharacterofaplaceorlanguage3.force(someone)tohavesexagainsttheirwilldeny dinaiv.1.declareuntrue;contradict2.refusetoacce
37、ptorbelieve3.refusetogrant,asofapetitionorrequest4.refusetolethave5.denyoneself(something);restrain,especiallyfromindulginginsomepleasure6.denyformally(anallegationoffactbytheopposingparty)inalegalsuit7.refusetorecognizeoracknowledgePara8inspiration,inspreinn.1.arousalofthemindtospecialunusualactivi
38、tyorcreativity灵感2.aproductofyourcreativethinkingandworkHehadlittlerespectfortheinspirationsofotherartists.3.asuddenintuitionaspartofsolvingaproblem妙计4.(theology)aspecialinfluenceofadivinityonthemindsofhumanbeings5.arousingtoaparticularemotionoraction鼓舞6.theactofinhaling;thedrawinginofair(orothergase
39、s)asinbreathing吸气Para12oriented:rientidadj.-adjustedorlocatedinrelationtosurroundingsorcircumstances;sometimesusedincombinationThehousehaditslargewindowsorientedtowardtheoceanview.Thefirstweekofthenewsemesterisdevotedtohelpingfreshmenbecomeorientedtocollegelife.Thebookisvalue-orientedthroughout.inco
40、rporate ink:preit,ink:prtv.1.makeintoawholeormakepartofawholeSheincorporatedhissuggestionsintoherproposal.2.includeorcontain;haveasacomponent3.formacorporation4.uniteormergewithsomethingalreadyinexistenceIncorporatethisdocumentwiththosepertainingtothesamecase.adj.-formedorunitedintoawholePara14imple
41、mentation,implimenteinn.1.theactofaccomplishingsomeaimorexecutingsomeorderTheagencywascreatedfortheimplementationofthepolicy.2.theactofimplementing(providingapracticalmeansforaccomplishingsomething);carryingintoeffectPara16pursue psju:,-su:v.1.carryoutorparticipateinanactivity;beinvolvedinShepursued
42、manyactivities.2.followinorasifinpursuitThepolicecarpursuedthesuspectedattacker.3.goinsearchoforhuntfortopursueahobby4.carryfurtheroradvanceShehasbeenacceptedtostudyatYaleandplanstopursueaPh.D.Para17advocate dvkeit,dvktn.1.apersonwhopleadsforacauseorpropoundsanidea2.alawyerwhopleadscasesincourtv.1.p
43、ushforsomething2.speak,plead,orargueinfavorofThedoctoradvocatedasmokingbanintheentirehouse.Para19unfold,nfuldv.1.developorcometoapromisingstage显露2.opentotheview呈现;Awalkthroughtownwillunfoldmanyinterestingbuildings.3.extendorstretchouttoagreaterorthefulllength展开4.spreadoutoropenfromaclosedorfoldedstate打开Thank You!