This brief comment is reproduced with permission from ISSOP (International Society for Social Pediatrics and Child Health) and was first published in its 2020 November e-bulletin №48.
It is 2020 and most of our medical training and clinical services are still structured around organ systems and diagnoses, i.e. “biomedically”(1,2). In this context, Social Pediatrics is the odd specialty by explicitly expanding the focus of our work beyond the human body. This idea was already expressed by Stefan Engel about 100 years ago: “Every pediatrician that fully understands his/her task, in the first place, has to be a social doctor” (Stefan Engel, 1878–1968). From the “biomedical” side of medicine such social commitment has often been perceived as “less” — less medical, less precise, less exciting.
In the 1970s, George Engel (no relation) proposed to combine the medical with the social model of health (3). This “biopsychosocial” perspective would allow health care professionals to care for their patients more holistically. Recognizing that health is more than the absence of disease, the World Health Organization (WHO) developed the International Classification of Functioning, Disability and Health (ICF) as a framework and classification system (complementary to the International Classification of Diseases — ICD) based on the biopsychosocial model of health (4).
This classification not only allows but explicitly asks us to look beyond body structures and functions and to consider how the context of a person influences their “involvement in life situations” (participation). Their individual background such as culture, ethnicity, race and environmental factors such as social attitudes, policies, access to housing, food and drugs, the climate, environmental disasters and political disputes become an official part of their health status.
The ICF is the canvas for us to paint all those details we notice about a child and what is happening in their life (and that often worry us). A picture that moves us to think out of the box, be innovative, creative and drives our passion to reach out to partners outside of the health system such as education and social services. As a classification, the ICF also allows us to capture, codify, document and aggregate systematically the pulse of our society by caring for the most vulnerable among us.
Once the ICF becomes an integral part of health documentation, electronic health records and health statistics, we will be able to do more than count numbers of diagnoses, deaths and recoveries. We will be able to tell how people are managing, identify common barriers and discover ways to facilitate their full participation. Implementing the ICF will help us build a society that is more open, more inclusive, more diverse and values collaboration.
If you are curious to learn more about the ICF, go to www.icfeducation.org
References:
1. Ronen GM, Kraus de Camargo O, Rosenbaum PL. How Can We Create Osler’s “Great Physician”? Fundamentals for Physicians’ Competency in the Twenty-first Century. Med Sci Educ. 2020;30(3):1279–1284. https://doi.org/10.1007/s40670-020-01003-1
2. Kraus de Camargo O, Simon L, Ronen GM, Rosenbaum PL, eds. ICF: A Hands-on Approach for Clinicians and Families. First. London, UK: Mac Keith Press; 2019. http://www.mackeith.co.uk/shop/icf-a-hands-on-approach-for-clinicians-and-families-ebook/.
3. Engel GL. The need for a new medical model: a challenge for biomedicine. Science (80- ). 1977;196(4286):129–136. http://www.jstor.org/stable/1743658.
4. World Health Organization (WHO). International classification of functioning, disability and health : ICF. 2001. https://apps.who.int/iris/handle/10665/42407.
