**3. Review of the development of social medicine**

In the past, medicine was mainly oriented towards the treatment of diseases. It began shaping as a science in the Middle Ages. Little attention was focused on factors that caused disease, and there was neither interest in the social environment and other environments in which man lived, nor in what the implications of disease were for human society, and their impact on human health (Pirc, 1980).

During the middle of the 19th century, medicine began to develop primarily as a pure natural science. Disease and health began to be associated with the operation of then discovered biological, chemical and physical factors that affect the human body and act in it. At that time, medicine began to ever increasingly focus on the causes of disease. Hygiene, the first science of protecting and improving health, appeared and deliberately started to discover the role of social environments. The activity occupied with the effects of hygiene, preventive medicine, and public health increasingly established itself and soon independently evolved into social medicine that began to explore the aetiological role of socioeconomic and educational conditions in which man lives, in the development of disease. Consequently, medicine became a socionatural science (Pirc, 1980).

Medicine, like any other branch of science and technology, is based on theory. It is perfectly possible to treat people, not being aware of the theory, let alone doubting the theory. Scientific information in medicine is derived from observations or experiments. Thus, in the 20th century, scientific achievements accumulated in natural sciences and medicine, and are still accumulating. Genetics, biochemistry, chemotherapy, surgery, psychoanalysis were all developed. As in all the centuries before, medicine in the 20th century reflected social and political conditions. Poverty, hunger, infectious diseases were all the main issues of health policy. Such conditions were fertile ground for the operation of social models in medicine, which at that time formed from the foundations of modern scientific achievements. According to the principal tasks, medicine is divided into curative medicine (with the objective of treating disease), prevention (aimed at preventing disease), and social medicine (which examines the socioeconomic determinants of health and disease). In Yugoslavia (Urlep, 1992) represented a sociomedical model of health care, thought up by the Croatian

year impact factor 1999 1 2000 1.165 2001 1.152 2002 0.624 2003 1.281 2004 1.051 2005 1.118 2006 1.481 2007 1.91 2008 2.176 2009 2.313 2010 2.267

In the past, medicine was mainly oriented towards the treatment of diseases. It began shaping as a science in the Middle Ages. Little attention was focused on factors that caused disease, and there was neither interest in the social environment and other environments in which man lived, nor in what the implications of disease were for human society, and their

During the middle of the 19th century, medicine began to develop primarily as a pure natural science. Disease and health began to be associated with the operation of then discovered biological, chemical and physical factors that affect the human body and act in it. At that time, medicine began to ever increasingly focus on the causes of disease. Hygiene, the first science of protecting and improving health, appeared and deliberately started to discover the role of social environments. The activity occupied with the effects of hygiene, preventive medicine, and public health increasingly established itself and soon independently evolved into social medicine that began to explore the aetiological role of socioeconomic and educational conditions in which man lives, in the development of

Medicine, like any other branch of science and technology, is based on theory. It is perfectly possible to treat people, not being aware of the theory, let alone doubting the theory. Scientific information in medicine is derived from observations or experiments. Thus, in the 20th century, scientific achievements accumulated in natural sciences and medicine, and are still accumulating. Genetics, biochemistry, chemotherapy, surgery, psychoanalysis were all developed. As in all the centuries before, medicine in the 20th century reflected social and political conditions. Poverty, hunger, infectious diseases were all the main issues of health policy. Such conditions were fertile ground for the operation of social models in medicine, which at that time formed from the foundations of modern scientific achievements. According to the principal tasks, medicine is divided into curative medicine (with the objective of treating disease), prevention (aimed at preventing disease), and social medicine (which examines the socioeconomic determinants of health and disease). In Yugoslavia (Urlep, 1992) represented a sociomedical model of health care, thought up by the Croatian

disease. Consequently, medicine became a socionatural science (Pirc, 1980).

Table 1. EJPH impact factor

impact on human health (Pirc, 1980).

**3. Review of the development of social medicine** 

doctor Dr Andrija Štampar during the 1920's. Andrija Štampar based all medical fields related to population health (hygiene, epidemiology, and other) on social medicine and human health. He was the first major proponent of this modern principle. He worked in former Yugoslavia, and was also one of the founders of the World Health Organization (Švab, 2004).

In Slovenia, we quickly followed the trends in preventive medicine by establishing the Central Institute of Hygiene, Ljubljana as early as 1923 (B. Pirc & I. Pirc, 1938), which became the National Institute of Public Health with the extensive network of regional institutions.

The aim of research in social medicine is to achieve enlightenment necessary for efficient and effective health care. Social medicine discusses health and health care based on the findings or results obtained from mass observation (Pirc, 1980). Health care is care for the health and progress of an entire regulated society, and for all social and economic activities that must accept this care as a task for the entire society, with each of them contributing in their field (Pirc, 1980).

#### **3.1 Definition of social medicine**

The term 'social medicine' was first used by Jules Guérin in Paris in 1848. Guérin divided social medicine into social physiology, social pathology, social hygiene and social therapy (Jakšić, 1994).

Here are some definitions of social medicine (Pirc, 1980) by the most famous authors in this field of medicine. The first definition is from 1904, formed by the first founder of social medicine, Alfred Grotjahn, and reads: '... as a descriptive science, it is the study of the conditions from which generalisation of the culture of hygiene, of communities, individuals and their descendants who live in local, temporal and social community, is dependent ... as a normative science, it is the study of measures which aim to achieve the generalisation of the culture of hygiene among all individuals and their descendants who live in the local, temporal and social community.'

In 1923, Prof Dr Andrej Štampar in his inaugural lecture as professor of hygiene and social medicine at the Medical Faculty in Zagreb defined social medicine as follows: '... science that deals with the study of interlinked social and pathological conditions in the life of the population, and with the development of measures of a social nature for improving human health.'

In 1962, Radomir Gerič wrote in his book *Social medicine*: 'Social medicine means care by the community, the state, and society as a whole for the health and wellbeing of the entire population. Ultimately, this would mean that social medicine is the same as population health care.'

In 1962, Mervyn Susset and William Watson wrote in the book *Sociology in medicine*: 'Social medicine is thus a complex and important branch of medical science in that it attempts to capture the nature of social processes as well as their relationship complicated with health and disease.'

From these definitions we can summarise that social medicine discusses disease and health from the perspective of society and its functions in health care relative to the social factors

Scientific Publishing in the Field of Social Medicine in Slovenia 385

Multiple authors both increase the credibility of a research work and the possibility of co-

In both the ZV and EJPH journals, the de Solla Price (1971) theory on separating articles into scientific and unscientific utilising the number of citations (scientific articles are those with between 10 and 20 citations, unscientific articles are those without citations), shows that all published articles were actually scientific articles. Similar results were also obtained at the Radiology and Oncology journal (in the period 1992-2001, there was an average of 18

citations r\*\* no. of

2003 47 19 2.47 438 23.05 230 59 3.89 1529 25.91 2004 56 24 2.33 452 18.83 360 79 4.55 2250 28.48 2005 64 21 3.04 466 22.19 448 103 4.34 2830 27.47 2006 46 20 2.3 566 28.3 411 93 4.41 2945 31.67 2007 49 18 2.72 445 24.72 415 90 4.61 3004 33.38 2008 65 20 3.25 658 32.9 453 97 4.67 3316 34.18 2009 66 20 3.3 648 32.4 435 91 4.78 2985 32.08 2010 61 22 2.77 651 29.59 458 99 4.63 3221 32.54 **total 454 164** 2.76 **4324** 26.36 **3210 711** 4.51 **22080** 31.05

authors

no. of

articles r\* no. of

citations r\*\*

ZV EJPH

Table 2. The number of authors and citations in the analysed articles, 2003-2010

In eight years, articles in both Slovenian and English were published in the journal ZV. Figure 1 shows the number of articles by individual years in Slovenian and English. Most of the articles in English were published by Slovenian authors. In 2003, four of the articles in English were by authors from the United Kingdom, Netherlands and Sweden, and three by authors from Slovenia. In 2004, one English-language article was by an author from Finland and one article by a Slovenian author. In 2005, the sole article in English was by a Slovenian author. In 2006, two articles in English were the result of international collaboration; one article was by authors from Slovenia and Germany, the other by authors from Slovenia and the United Kingdom. The authors of the remaining four articles were from Slovenia. In 2007, one article in English was by authors from Serbia, and five articles again by authors from Slovenia. In 2008 and 2009, all articles in English were by authors from Slovenia, while in 2010 one article was by authors from Albania, and one article was again the result of collaboration by authors from Slovenia and the Netherlands. All the remaining five articles in 2010 were again written by Slovenian authors. Publishing foreign authors in the journal ZV was more of an exception; the reason Slovenian authors published articles in English may well be the result of those articles being written and prepared for publishing in a foreign journal, then due to a possible rejection, the Slovenian authors decided to publish in local journals. The English-language articles published by Slovenian authors were the result

financing research projects.

no. of authors

year

Legend:

references for each article) (Musek et al., 2003).

articles r\* no. of

no. of

r\* - ratio no. of authors / no. of articles r\*\* - ratio no. of citations / article

that are present in real social communities and the entire population. It considers in its scientifically founded proposals both the interests of a defined society and the actual possibilities in it.

Everything is changing, so it is important to adapt to new conditions when we try to implement principles such as concern for the social conditions of life, an integrated approach to health care, and the importance of learning. The future must not repeat the past, but must spring from it. Social issues are not only a biological phenomenon, but are linked to the social sciences and culture that emphasise the importance of moral issues (Jakšić, 2004).
