Correspondence

Toward a Social Policy for Health

N Engl J Med 1993; 329:1969December 23, 1993

Article

To the Editor:

Hurowitz (July 8 issue)1 argues for a social policy for health whereby the medical care system focuses on responding to unavoidable diseases, and social problems are resolved through other means. We believe that the solutions he proposes needlessly handicap both physicians and patients. Physicians and other providers of health care and social services should work collaboratively. Physicians should assess the interaction of the social context with health and illness, for example, in caring for patients with hypertension or diabetes. In treating a person with diabetes, it is important to know about diet, the ability to afford appropriate food, and who cooks.

We applaud Hurowitz's efforts to discuss these broader issues, but we encourage the adoption of another approach. Our recommendation is to acknowledge the connections among health, disease, and the social context; look for solutions that emphasize these connections; and foster collaboration between physicians and other providers. We believe this approach can provide more cost-effective care with better outcomes for patients.

William B. Shore, M.D.
George W. Saba, Ph.D.
University of California, San Francisco, San Francisco, CA 94143

1 References

1. 1

   Hurowitz JC. Toward a social policy for health. N Engl J Med 1993;329:130-133
   Full Text | Web of Science | Medline

Author/Editor Response

Dr. Hurowitz replies:

To the Editor: I strongly support the idea that physicians should address the social factors that are related to medical illnesses. I believe, however, that physicians should primarily concentrate on providing medical care for acute and chronic diseases -- an area in which we already excel. This is not an extreme or exclusionary position. If they wish, medical schools can develop curricula and individual physicians can expand their interest in the social context of medical illness.

Physicians should continue to collaborate with other providers. I would prefer, however, to see a new subspecialty in which physicians pursue graduate training in the social sciences related to health. I envision a new generation of academic physicians trained in medicine and the social science of health. This training would occur through the proposed National Institute of Social Health and academic institutions that receive funding from the institute, with the goal of clarifying the social factors that seem to lead to so much ill health.

James Conn Hurowitz, M.D., S.M.
18 French Dr., Boylston, MA 01505