SOCIAL HYGIENE

The following manual for students of social hygiene reflects the new attitude towards health and disease in the 80s, as well as, towards the new mass phenomena taking part in our society. This new approach, however, does not deviate from the subject matter of the social hygiene and the social aspects of medicine as a whole - further, it advances the fundamentals of socialist health care as postulated by the classics of soviet social medicine - Prof. N. Semashko /1874-1949/ and Prof. Z. Soloveyev /1876-1928/ - namely, for a creative synthesis between clinical and prophylactic medicine.

The main objective of the social hygiene science is to give a professional estimate for the role of the social factors connected with the health status of the patient. This knowledge should be supportive in two aspects:

1. as a coordinative effort for the work of the primary health care physicians /i.e., working in the rural, urban, industrial and other general practice districts/ and for health care managers as a whole;

2. as a connection or link between the principal community leaders and the health authorities on the other hand;

The question of health care organization and management has been a priority for bulgarian medicine, since, the revival processes of the new emerging bulgarian nation developed in the 19th century. At that time, it reflected the Russophile and Russophobe tendencies among the bulgarian medical intelligence. Later, social hygiene got its own face in the period between the two world wars, and, was an instrument in the monopolistic strivings of the ruling class. With the socialist revolution on 9 September 1944, there was a process for socialization of medicine to the left - as given by the many correctives in the "Public Health Law" - which, is continuing up to now in the light of the "Health for All" era. In the last years, Soviet, Bulgarian and other authors give a new dimension to the social hygiene problematic, effectively, in the climate of World Health Organization directives.

We shall continue to aim at a collaborative place of our discipline among the other medical specialties. Human health has always included its social components, and, at this stage the clinical-social approach is the one that gives a real value to the relation between physician and patient - epitomized, as an object of medical activity. However, the development of social hygiene has always shown a facility towards methodological re-armament /i.e., at the present moment, the available methods are cumbersome, time-consuming and don't give excellent answers to emergency questions/. The socialist community have to respond to this tasks and requirements with new propositions.

This new book have kept the structure and organization of the previous manuals for students education - viz., textbooks from Prof. Angel Panev, Prof. Petar Kolarov and Prof. Hristo Petkov as long term titular and head of the Department of Social Medicine and Health Care Organization. Their consolidated efforts led the Public Health science in this country up to the end of the Cold War era. The editor has been taking into account the possible short-comings of a text with tuition orientation. It is hoped that some additional literature and other illustrative material will help the reader. Every critical notes and proposals will be accepted by the editorship, thankfully.

(i). Prof. Nikolai Semashko /1874-1949/.

(ii). Prof. Zinovi Soloveyev /1876-1928/.

Addendum: We didn't intend to write an essay on this topic, but few words for a commentary are necessary. Beside the fact that the authors of the above book are important figures in socialist public health and further worth mentioning is that everything written by K. Gargov and collaborators has been treated with great respect and studied carefully from their students. The man has been an apostolic figure for bulgarian social hygiene and that kind of treatment was characteristic of socialism itself. Otherwise, merits of the books are poor /i.e., as compared to western literature of the same caliber/, but good and very good as judged from the eyes of the former socialist block. That seems enough for a qualitative assessment for the book.

Second question is the field of general practice or family medicine and the concept of health center /polyclinic/ staying as kernel of it. This subject stays, somewhat, aside from the scope of the public health discipline. Yet it is indispensable part from the health sciences - together, with medicine and hygiene from a historical point of view. My knowledge on the evolvement of the discipline is scarce and I am not going to dwell on it. I want to say in a nutshell, whether, this is a job about the insured patient and since insurance medicine comes to be a subsidiary of state - subsequently, general practice appear from the sense of the logic to be a retail service. As a counterpoise, herewith, comes major pharmaceutical firms with developed marketing branch and they take contracts from the state - subsequently, by offering grants and providing expertise they give jobs to a third party specialists. Thus a major cycle of an outpatient health service is precluded.

Third question is " ... health centers or similar organizations in many countries stress preventive services, such as, immunization, counseling, maternal and child care. Especially, if the centre is responsible for a defined population /defined geographically or as members-subscribers/, it may have screening programs and follow-up procedures, widely practiced by "dispensaries" which function as ambulatory care facilities for patients with specific diseases such as tuberculosis or venereal disease." - extracted from R. Kohn. The health centre concept in primary health care. Copenhagen: WHO Regional Office for Europe, 1983 (Public Health in Europe № 22).

Fourth question is " ... Moscow International WHO Courses for Health Administrators are conducted on a regular basis, since, 1962 at the Central Lenin Order Institute for Advanced Medical Studies. Over the elapsed time, three stages of development can be delineated. The first stage (1962-1975), was a period of growing international popularity of the courses. The second (1976-1979), was characterized by decline in popularity and countries being reluctant to send participants away for a long-lasting training period. The third phase (1980 to date) was marked by improvement in the general situation, increased number of participants and introduction of some technological innovations in organization of the learning process." - extracted from F. Vartanyan, E. Shigan, V. Kant, I. Pustovoj, D. Orlov, V. Leontiev, V. Yermakov, V. Deryabina, V. Stonogina, L. Lozanov, A. Vylchev, N. Kolev, S. Marinova (editors). Development of National and International Health Trends. Sofia: Izdatelstvo na CNIMZ, 1986 (Proceedings of the 7^th Scientific Session of the Moscow International WHO Courses for Health Administrators, Varna, 1-4 April 1986).

Fifth question is the dimensions of primary health care reform, which, has been taking place in Bulgaria from the early 90s. The reform has been following the patterns of "Health for All" initiative of WHO. By the year 2000 and its evaluation phase has been finished. The implementation of the country profiles has been task of the separate Ministries of Health and from other participating bodies.