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The
Department of Social Medicine and Health Policy was established in 1980
by Harvard Medical School's new Dean, Dr. Daniel Tosteson, who invited
Dr. Leon Eisenberg to be its chair. The department's organizational
predecessors were the Department of Preventive Medicine and the Center
for Community Health; in addition, several prior academic programs contributed
to the development of the Department of Social Medicine's fundamental
academic core in the social sciences basic to medicine. Under the Center
for Community Health, Professor Rashi Fein led a postdoctoral fellowship
program in Health Policy, Economics and Political Science for MDs and
PhDs. This five-year program, begun in the late 1960s, funded by the
Rockefeller Foundation, benefited over 25 fellows, many of whom are
influential in academic health policy today. The Center represented
a tradition of social action, real-world research, and cross-departmental
activities, such as the fellows' project on a model for prepaid clinical
practice initiated at the Massachusetts General Hospital. The Center
also administered the medical student clerkships in the Southwest, serving
American Indian communities.
A seminar on "Culture, Medicine and Psychiatry," organized
at Harvard in 1975-1976, funded by the Robert Wood Johnson Foundation,
and led by Professor Leon Eisenberg, Arthur Kleinman and Byron Good,
provided another intellectual seed for the future Department of Social
Medicine. This seminar generated interdisciplinary excitement, attracting
faculty as well as graduate students from the history of medicine, anthropology
and sociology. Presentations from seminar meetings became the initial
volume of Culture, Medicine and Psychiatry: An international journal
of comparative cross-cultural research, founded by Arthur Kleinman.
Dr. Julius Richmond and Dr. David Hamburg, pediatrician and psychiatrist,
were also influential in DSM history. Dr. Richmond chaired the HMS Department
of Preventive and Social Medicine from 1971-1977, then joined the Carter
Administration as Assistant Secretary of Health and Surgeon General
from 1977-1981. Dr. Hamburg served as John D. MacArthur Professor of
Health Policy, a cross-school appointment at HMS and the Kennedy School,
from 1980 to 1982. Prior to his assuming the presidency of the Carnegie
Corporation in 1983, Dr. Hamburg launched various University-wide initiatives,
including one on child health and one on Medicare reform. When Dr. Richmond
returned to Harvard from government service in 1983, he was appointed
the John D. MacArthur Professor of Health Policy.
As Chair of the new department, Leon Eisenberg sought to build and establish
an interdisciplinary social science faculty in medical anthropology
and history of medicine. In 1982, he recruited Arthur Kleinman to lead
the development of medical anthropology, with Byron and Mary-Jo Good;
he also appointed Allan Brandt and Harry Marks to teach and carry out
research in the history of medicine. Dr. Lynn Peterson, a surgeon and
ethicist, joined the department to lead the development of a new Division
of Medical Ethics in 1989. All faculty taught courses for medical students
and advised students in research, in international health and medical
anthropology, in history of medicine, in ethics and in health policy.
In 1984, a separate Department of Health Care Policy was established
at HMS, and the department took the name Department of Social Medicine
(DSM), which continues to the present.
During the first decade of the DSM, several fellowship programs were
instrumental in shaping the intellectual direction of the department.
These included the MacArthur Foundation grant to support HMS medical
students to pursue PhD work in the Faculty of Arts and Sciences, particularly
in anthropology and history of medicine; an NIMH training program in
"clinically relevant medical anthropology" focused on culture
and mental health services; and a pre- and postdoctoral program in history
of medicine. The Carnegie Fellowship program in Health and Behavior
in East Africa (1989-1999) added to the growing number of international
postdoctoral fellows and visiting scholars who joined the department
each year to further their work in medical anthropology, history of
medicine and the social sciences. The DSM developed as a bridge between
the medical school and the Faculty of Arts and Sciences, as faculty
and students developed affiliations with the FAS through appointments,
educational programs, teaching and research.
The Division of Medical Ethics, directed by Professor Allan Brandt since
1997, expanded during the DSM's second decade as well, developing a
rich network of medical ethicists in the HMS teaching hospitals and
public programs designed to stimulate consideration of some of the most
pressing ethical issues associated with developments in contemporary
biomedicine. Academic programs for medical students, clinical faculty,
and postgraduate fellows in medical ethics were developed as new faculty
and staff joined this increasingly influential set of programs.
Professor Arthur Kleinman was appointed chair of the DSM in 1991 and
led the DSM into its second decade, continuing and strengthening academic
programs in medical anthropology, the history of medicine, social and
health policy, the humanities, and medical ethics. Under his leadership,
many DSM faculty and fellows contributed to the world mental health
report -- published as World Mental Health: Problems and Priorities
in Low Income Countries -- which has been influential in placing mental
health on the international public health agenda. Other research programs,
including those supported by the Center for Studies in Culture and Medicine,
included studies of ethnicity and psychiatry, medical education, biomedicine,
biotechnology, and oncology, as well as studies of suicide and mental
illness in China. The Department continued its commitment to postdoctoral
training programs, with the NIMH program and the Carnegie East Africa
fellowship program and an expanding visiting scholar and fellowship
program. The Freeman Foundation Fellowship for China and Southeast Asia
was founded in 1996, and has brought physicians and social scientists
from China, Hong Kong, Indonesia and Thailand as postdoctoral fellows.
On-going collaborative research and educational activities have developed
and have been complemented by faculty exchanges and collaborative research
in China, Indonesia, Peru, Haiti, Kenya and Tanzania. Medical students,
undergraduate and graduate students, and NIMH fellows benefit from visiting
scholars from around the world.
The second decade also witnessed the establishment and growth of the
Program in Infectious Disease and Social Change (PIDSC), headed by Paul
Farmer, Jim Kim, and their team of socially active anthropologists,
physicians, and medical students. PIDSC has been linked since its inception
to Partners In Health (PIH), a not-for-profit NGO committed to social
justice and to providing health care in a partnership with the poor
in Boston, Haiti, Peru, and other low-income societies. PIDSC and PIH
have received support from the Open Society Institute and the Gates
Foundation to develop innovative programs to treat multi-drug resistant
TB and HIV, leading a global campaign to bring quality medical care
to persons living in poverty, particularly in Haiti, Peru and Russia.
PIH relocated from its offices in Cambridge to the Department of Social
Medicine in 2000, bringing the academic work of the DSM and the commitment
to linking medical care to issues of social justice into closer relationship
with one another. In 2001, the Department of Medicine in the Brigham
and Women's Hospital initiated a Division of Social Medicine and Health
Inequalities, with strong links to the DSM.
The Program in Urban Health was founded in 1999, under the leadership
of Patricia Case, to bring special attention to problems of health in
urban communities in the US. The Program has focused particularly on
conducting research on drug use and infectious diseases in Boston and
New York City.
Professor Byron Good was named Chair of the DSM by HMS Dean Joseph Martin
in 2002 (he served as acting chair from the academic year 2000-01),
as the DSM enters its third decade. The Department has continued to
expand, building on the strengths of its academic programs and its growing
commitment to respond to many of the most important global health problems
of our era -- MDRTB, HIV/AIDS, mental health problems, and drug abuse.
At the same time it maintains its commitment to the education of physicians
in the social sciences and humanities, with a goal of supporting the
development of humane and socially minded physicians. The Department
continues to foster interdisciplinary research, thinking and teaching,
focused on the common and historical themes of social medicine. New
programs in global and community mental health represent a new emphasis
on concerns as old as the Department. A continued interest in the social,
cultural and ethical dimensions of new medical technologies represents
the DSM's commitment to confronting central dilemmas of medicine in
our generation.
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Julius Richmond,
MD
United States Surgeon General, 1977 -1981
Department Chair 1971-1977
Leon Eisenberg, MD
(3rd from left) serving as a member of a WHO scientific group on mental
health research.
Department Chair 1980-1991
Arthur Kleinman (left)
and former President Jimmy Carter exchanging ideas about global health.
Department Chair 1991-1999
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