Rudolf Virchow, poverty and global health: from “politics as medicine on a grand scale” to “health in all policies”

Abstract

The German pathologist and politician Rudolf Virchow proposed the concept of sociomedical causation, emphasising the role of social and environmental factors in the aetiology and prevention of diseases. Virchow's achievements are threefold: he was a founder of scientific biomedicine, he characterised medicine as a social science as much as a biological science and he promoted and improved public health. In his landmark report of a typhus epidemic in mid-19th century Germany, Virchow drew a connection between the epidemic and poverty and living conditions. He proposed radical social reform and stated that, “medicine is social science and politics nothing but medicine on a grand scale”. The task of medicine was therefore not merely to treat disease but also to contribute to the health of the entire population. Virchow realised that, in order to improve the health of the public, medicine must attend to both its biological and social underpinnings. His work has had far-reaching consequences for the development of public health and medical sociology. As in Virchow's times, poverty, deprived living conditions, malnutrition, crowding and economic insecurity determine to a high degree the prevalence of disease and life expectancy in low- and middle-income countries today. Sociomedical causation is not limited to infectious diseases but also extends to the contemporary pandemics of non-communicable diseases. Obesity and other non-communicable diseases cannot be addressed effectively without considering and acting on the social determinants of health. The concept of “health in all policies” has emerged with the goal of promoting political action addressing the social determinants of health. This concept concerns prevention of disease, promotion of a healthy lifestyle and improvement of factors potentially harmful to the health of entire populations. The current “health-in-all-policies” reforms in China may advance the global evidence base for the prevention of chronic disease in low-, middle- and high-income countries.