The (re-)making of histories of social medicine across both place and time is a welcome endeavor, for the arena’s past, like its present, remains ever in formation (or gestation) amid breakers of remembering and forgetting. This afterword, unabashedly charting scholar-activist tendencies, offers an aspirational call for social medicine as a political endeavor to be articulated at both a grand and quotidian scale, forwarding possibilities of social medicine becoming a social movement, and social movements becoming more entangled with social medicine.

Notwithstanding the volume’s titular global dalliance, the exercise of revisiting social medicine underscores the overarching importance of the context of – as well as conversations among – the book’s fascinating and original accounts. Necessary and deft incorporation of, for example, more women, key players from the Middle East/Arabic-speaking world, sub-Saharan Africa, Asia, and the Pacific, the socialist world, and racialized social medicine thinkers and practitioners from across the Americas, nonetheless begs a query or two regarding how the role of (male) European and white physicians – in this volume mercifully far less dominant than in virtually every other past account – might be further challenged.

Transcending Doctors and Politics

Myth-and-icon-busting might appear to detract from crucial narratives and learnings that continue to inspire the next generations and present alternatives to biomedical triumphalism. Instead, I would argue that constructive challenging of the usual cast of male social medicine icons only heightens the field’s potential reaches and repercussions. In India and Sri Lanka, communist and Third World feminist physician-activists played pivotal roles in proffering homegrown, unpretentious approaches to transforming health through redistributive approaches that transcended or even countered European and imperial social medicine understandings.

What might an even deeper focus on medicine’s humble rank-and-file practitioners – midwives, nurses, Indigenous healers, community health workers, among others – tell us about the promise and challenges of social medicine in the streets and in the polis, from the two Bandungs to Alma-Ata to Rio? After all, Mozambique’s agentes polivalentes elementares (sanitary cadres) were a cornerstone of the 1960s–70s revolutionary struggle against Portuguese colonialism.Footnote ¹ How did this medicine of liberation approach interact with, and especially inform, primary healthcare and social medicine efforts of the day?Footnote ² Exploring such questions might lead us to think through how perennial revivals of social medicine, and historical studies thereof, might propitiously focus on and engage with health workers who are closest to made-marginalized communities that are putatively of most concern to social medicine praxis.

Another illustration from the same era relates more directly to the World Health Organization (WHO)–UNICEF 1978 International Conference on Primary Health Care, considered by many to be a pinnacle of global social medicine approaches articulated through the United Nations (UN). At the conference and in its preparations, physicians, politicians, and physician-politicians (or physician-international bureaucrats) were visibilized over everyday health workers in both speeches and in the crafting of the Alma-Ata Declaration. Moreover, WHO and Western primary healthcare advocates accused Soviet health approaches of being overmedicalized or over-doctored. Yet even as Soviet authorities sought to showcase medical-technological advances, conference participants themselves remained hungry to see social(ist) medicine on the ground, that is, in the (Central Asian) yurt, witnessing through site visits “not only universal, free, equitable healthcare coverage, but health protection writ large, in terms of housing, sanitation, employment, nutrition, education, elimination of poverty, and so on.”Footnote ³ There, the interlocking roles of ordinary social workers, community health agents, teachers, and others were far more transcendent (and memorable) than politician-physician pronouncements.

Struggling for Health, Backward and Forward

The Fabian approaches of many past (and certain present) social medicine leaders, who tend(ed) to pursue connections to parliaments, philanthropies, UN agencies, and elite universities, reveal both limits and possibilities. Such associations with “the establishment” certainly portend(ed) political access but also risk(ed) increasing the distance from struggles on the ground. Here, 1930s union activism and people’s militancy for bona fide social and working condition improvements, whether in Argentina, Scandinavia, or China, merit being mined for conceivable or realized intersections and routes between mobilized laborites and social medicine acolytes. Likewise, dialogues and solidarity between anti-colonial uprisings and anti-racist resistance may well have incorporated social medicine activists and demands.Footnote ⁴ How did, for instance, radical peasant unionists in Mexico perceive and interact with health advocates, who themselves pushed and shaped the progressive physician-advisors to President Lázaro Cárdenas’s leftist administration?Footnote ⁵ That agrarian reform and (social) medicine’s centrality to the revival of traditional collective landholding communities (ejidos) unfolded simultaneously urges us to study far more than the heartfelt and eloquent ideas of physician-activist leaders of the period.Footnote ⁶

Amplified routes of understanding also emerge via foci on other unexpected social movement–social medicine intertwining, such as between early twentieth-century Tunisian feminist physicians and anti-colonial movements. Similarly, links between theological and medico-political liberation movements in repressive regimes in Brazil, Central America, and elsewhere might lead us to double back on perhaps not-so-strange science–religion bedfellows to glean new insights on social medicine’s varied engagements.

Moving forward in time, how might the dynamic accounts of the previous chapters provide perspectives and touchstones for social medicine’s current endeavors? In 1935, Uruguayan painter, sculptor, theorist, and parent of Latin American constructivism Joaquin Torres García famously sketched the first of his inverted maps of South America to introduce his text “School of the South,” declaring, “the South is our [magnetic] north.”Footnote ⁷ So might renewed social medicine histories and calls to action make exciting inversions and incursions, by heeding the compass of social movements and activism in the South.

Cuban “social medicine across borders,” perhaps the most obvious contemporary exemplar, may be more fraught than meets the (romanticized) eye. Still, the last half-century-plus of South–South medical cooperation remains a crucial starting point, not least because it brings to the surface to-be-further-unpacked dimensions of how social medicine grapples with “the biological and the social.”Footnote ⁸ Latin American social medicine studies that highlight tensions of the technical versus the political serve several guises: certainly as a hiding place for leftist radicals but also as a place of contestation amid claims of horizontal international South–South health cooperation.Footnote ⁹

The involvement of social medicine in progressive, so-called Pink Tide administrations that have ebbed and flowed across Latin America since the turn of the millennium offers a cautionary tale. Transformative social redistribution in the name of health has long been a fundamental social medicine ambition. But what happens when such redistribution is extractivism-based and leads to widespread destruction of Indigenous communities, lands, and livelihoods, not to mention further driving the climate crisis and jeopardizing the planet’s very survival?Footnote ¹⁰ Clearly historians of social medicine should play a role in examining such dilemmas. Analogous moments of crisis worthy of a historian’s analytic gaze might be evidenced in health movements that challenge capitalist and imperialist hegemony yet fail to confront patriarchy in their own practices.

In sum, here’s hoping that the volume invites (history of) social medicine’s more sustained focus on social movements, comprising sociopolitical incorporation of made-marginalized people(s) and struggles around political/policy transformations and revolutions related to health justice, Indigenous rights, workers’ rights, racial justice, gender justice, and environmental justice, to name but a sextet of movements. A solidifying handle on institutional dimensions of social medicine involving the state, academe, the medical profession, and the medical complex enables such an expanded focus on people’s health struggles. The reflections emerging from these chapters herald an exciting, productive, and much needed wave of novel approaches and insights on social medicine’s pasts and futures. Such a storied field, certainly needs (to make) more stories.