Street Medicine, Social Medicine and Social Care Defined
Figure 5. Psychiatrist, family doctor, and physician assistant visit a patient in the field. Taken by Margaret Molloy.
Definition of Street Medicine
The Street Medicine Institute provides the following description:
Street Medicine includes health and social services developed specifically to address the unique needs and circumstances of the unsheltered homeless delivered directly to them in their own environment. The fundamental approach of Street Medicine is to engage people experiencing homelessness exactly where they are and on their own terms to maximally reduce or eliminate barriers to care access and follow-through. Visiting people where they live—in alleyways, under bridges, or within urban encampments—is a necessary strategy to facilitate trust-building with this socially marginalized and highly vulnerable population. In this way, Street Medicine is the first essential step in achieving higher levels of medical, mental health, and social care through assertive, coordinated, and collaborative care management.10
Figure 6. Physician Assistant, Carrie Kowalski, tends to a patient with mobility issues in a local motel. Taken by Rose Garcia of The People Concern.
Definition of Social Medicine
Although the relationship between social factors and health had previously been recognized, Rudolph Virchow is seen by many to be the founder of social medicine. The German physician, while investigating a typhus outbreak in Prussia in 1848, found that social factors such as poverty and lack of education contributed to the epidemic.11
American physician, George Rosen, summarized the fundamental concepts of social medicine as the following:
- Social and economic factors impact health, disease, and the practice of medicine.
- Population health is a societal concern.
- Medical and social interventions are necessary for the prevention and treatment of disease.12
The homeless community currently suffers from untreated or inadequately treated physical and mental health conditions alongside the severe material deprivations and precarities of poverty. It is impossible to completely disentangle these social and medical factors, necessitating an integrated approach to lift up and treat these patients across the domains of their life.
Figure 7. A clinical case manager visits a patient in the field. Taken by Carrie Kowalski of Venice Family Clinic.
Definition of Social Care
Social care is a holistic approach to providing care that focuses on addressing and supporting patients’ complex health and social needs.13 Social care can include assistance with activities of daily living, such as laundry, shopping, cooking, cleaning, and other errands.14 It also includes care provided by social workers and case managers, who identify patients’ needs and provide them with the support that suits their preferences.15
An example of social care is the state of California’s In-Home Supportive Services (IHSS) Program. Patients who are transitioning from street homelessness into housing will often require some form of social care, such as IHSS or case management, to maintain housing.