[The present and future of social medicine]

There have been far-reaching structural changes in medicine in recent years, prompting us to review the social medicine from the time it was first officially included in the medical curriculum of instruction and examination of licensed physicians (1970) to the present day. This subdiscipline focuses on the specific interactions between medicine and society on the one hand and on the structures and functions of public health services in an ever-changing society on the other. Diseases and their sequels are considered to occur on a somatopsychosocial plane. Analysis of the close interaction between health and social factors affords a view on the problem of social inequality and disease or its sequels and the way they are attacked or overcome in our society, from the legal claim for assistance to the complementary help offered by a socially oriented structure of medicine. This is the range of operations of sociomedicine, concentrating mainly on prevention and rehabilitation. Epidemiological analysis is one aspect, individual social medical expertising another, both of them being important instruments in affording help within the framework of statutory health insurance allowances (sickness insurance, pension fund, medical care insurance, unemployment insurance and the like). In the future, increasing importance will be attached by reflecting the social consequences of developments in medicine and vice versa. This, in turn, will have an influence on the scientific and social approaches practised by social medicine.