Læknaneminn - 01.12.1976, Page 29

fession. Many academics in departments or su-
bjects variously described as preventive medi-
cine, community medicine, public health and
comprehensive medicine said they would prefer
to name their subject social medicine. In what
follows that term will be used as the least con-
fused rubric from the academic standpoint.“
I Bretlandi hefur Jrróunin orðið sú, að háskóla-
deildir er áður voru kenndar við Public Health, hafa
breytt starfsemi sinni og nafni í takt við breyttar
kröfur tímans, fyrst í félagslækningar á 5. og 6. ára-
tugnum, en síðar í samfélagslækningar (community
medicine) í byrjun 8. áratugs til samræmis við þær
breytingar er gerðar voru á heilbrigðismálum í
Bretlandi, endurskipulagningu National Health Ser-
vice. Hefur áherzlan smám saman færzt frá heil-
brigðiseftirliti, smitsjúkdómum og sýklafræði yfir á
félagsvísindi, skipulagningu heilbrigðisþjónustu og
stjórnun. I Edinborg má segja að þessi þróun hafi
gengið í gegnum aukastig, Public Health Admini-
stration, er opið var einnig öðrum en læknislærðum.
Forsvarsmaður þess skóla var núverandi landlæknir
Skota, Sir John Brotherstone, er var áður prófessor
í Social medicine í Edinborg. Hann var einnig sá er
mest kom við sögu endurskipulagningu heilbrigðis-
þjónustu Skota, sem fæddi af sér nýja sérgrein,
Community Medicine, er hér kallast samfélagslækn-
ingar. I svokölluðum White paper, er nefna mætti
frumvarp að lögum, segir svo um samfélagslækning-
ar:
„Put at its simplest, community medicine is con-
cerned with the study of health and disease in po-
pulations. The function of the specialist in com-
munity medicine is to investigate and assess the
needs of the population so that priorities may be
established for the promotion of health, the pre-
vention of disease and the provision of medical
care. The specialty is also concerned with co-
ordinating medical expertise so that policies
which are in accord with medical need can be
presented to the central department, area health
authorities, and those responsible for the manage-
ment of services below area level. We consider
that the specialty has a major contribution to
make to successful integration of medical work.“
í ritinu Community Medicine in Scotland, gefið úl
af skozka heilbrigðismálaráðuneytinu 1973, segir
svo um þróunina frá heilbrigðisfræðinni til samfé-
lagslækninga:
„The appreciation of relationship between factors
in the environment and the causation and fre-
quency of disease is an ancient one in medicine
that dates at least from the time of Hippocrates.
It was not until the middle of the nineteenth cen-
tury, however, that a distinct group of doctors
emerged whose specialist interest was the study
of the behaviour of disease in populations rather
than in individuals. At that time these doctors in-
vestigated the circumstances in which disease oc-
curred and they saw urgent sanitary reforms as
the first step in the prevention and control of in-
fectious diseases. The resulting public health
movement was outstandingly successful in its day.
One aspect of the practice of community medi-
cine therefore is in direct succession to this spe-
cial concern with preventing disease in popula-
tions by first studying the circumstances in which
it occurs. The important causes of death, disa-
bility and ill-health in this country are no longer
communicable diseases but rather the degenera-
tive conditions, long-continued chronic disease,
including mental handicap and illness, and the
il!-defined minor conditions so often seen in gen-
eral practice.“
Og síðar:
„Community medicine seeks to understand the en-
vironmental social and behavioural associations
with these conditions and where possible 'to use
that understanding in the prevention of disease.
Its investigations, like those of the nineteenth
century pioneers, are epidemiological, that is to
say based on populations rather than individuals,
and are concerned with the distribution and de-
terminants of disease in human communities.“
Af þessum tilvitnunum ætti að verða ljóst hið
nána samband félagslækninga og samfélagslækninga,
nöfnin að nær öllu leyti ákvörðuð af pólitískum að-
stæðum í hverju landi fremur en eðlismun milli þess-
LÆKNANEMINN
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