Tuesday, December 6, 2016

EcoHealth, One Health, Virchow and social medicine

This is adapted from a extract of a chapter I wrote (called "Tibetan protest self-immolation in China: reflections on ecology, health and politics")* for the book "Society, Ecology and Health", edited by Dr Maya Gislason, published in 2013 by Emerald Press.

There is an under-appreciation, within both EcoHealth and One Health, of the relevance and importance of the work of Rudolf Virchow, the outstanding German medical scientist of the 19th century, still remembered for his contribution to pathology, social medicine and, as mentioned, “One Health” (Mackenbach, 2009). However, these achievements are not recognised equally by in their three intellectual descendants (social medicine, one medicine (now One Health) and pathology). 
The European Society of Pathology still publishes Virchows Archiv. Here, I focus on Virchow’s other two major contributions.
The birth of social medicine
In 1848 Virchow helped establish a weekly publication called die Medizinische Reform (Medical Reform). In the brief window of time and liberal thought then crossing Europe, this journal promoted the cause of what is still widely called “social medicine”. This publication is reported to have had headlines such as “medicine is a social science” and “the physician is the natural lawyer of the poor (Brown & Fee, 2006). Social science, at that time, was very young, but was then as now, focussed on efforts to reduce inequality. Virchow is said to have been inspired by his countryman, Friedrich Engels, who had recently published (in German) “The conditions of the working class in England(Engels, 1845 (reprinted 1958)) a foundational text of social medicine. Engels described the dreadful poverty and squalor in the slums of the industrialising city of Manchester, which he linked to bad health.
It is as if Virchow has three lineages, none of which integrate even two of his major contributions (including social medicine and health promotion, neither of which shows convincing understanding of ecological issues) (Butler & Friel, 2006). On the other hand, EcoHealth (ie as aspired to by the International Association of Ecology and Health) seems close to blending at least two. But while one foundational paper relevant to EcoHealth states “pioneers such as Snow, Koch, and Budd knew that social factors had a strong influence on infections” (Parkes etal., 2005), this paper does not mention Virchow, though his younger colleague and rival, Robert Koch, is named. This would seem hair-splitting were it not that Virchow is so central to infectious diseases and One Health. There is at least one important exception, however, found in the writing of David Waltner-Toews:
“nowhere in the recommendations do the .. authors discuss altering the economic and political causes of disease emergence. .. one would think that health practitioners should be making strong health representations to organisations .. on how to prevent the mess in the first place. This is one of the many instances where we can see that the ideological lenses through which health and disease are studied constrain the opportunities to find solutions. This, if nothing else, should raise a warning flag that those who study disease are not necessarily well-equipped to promote health and that new modes of thought which can incorporate multiple perspectives are required” (Waltner-Toews,2004) (p 12).

[1] Koch (1843-1910) lived long enough to be awarded the Nobel Prize (in 1905). In later life Virchow, by then the doyen of German science, tried to suppress Koch’s growing recognition (Feldberg,1995; Strick, 1998). Strick also argues that Koch was politically conservative, with little if any sympathy for social medicine.

* See also my essay: Tibetan protest self-immolation: ecology, health and politics published in the Tibetan Review, January 2015