Ideology, social policy, health and health services: A field of complex interactions

As in any area of socio-economic reality, ideological interpretations influence our understanding of matters related to health and health policy. Ideologies simplify and fudge issues. Yet ideologies, social movements and social research relate to each other in complex ways, and there are also innovative and creative aspects to this relationship. After a brief general discussion of ideologies, the paper examines the significant insights gained from analysing the role of ideologies (dominant, radical and subordinate) in class societies: much of this is relevant, by analogy, to the field of health. Various explanations of health and ill-health are then discussed. While capitalist socio-economic organization has undoubtedly had negative health effects, capitalist societies are neither as uniform nor as unreformable as Marxist analysis (and ideology) suggests. Similarly, there is exaggeration in Illich's description of the ills of industrialism. Yet his concept of the medicalization of health helps to understand how the dominant conception of medicine and the ideologies dominant among health professionals interact to create institutions--also in wider areas of health planning--that express the power of physicians and benefit elites. These effects are particularly acute in capitalist societies. As for the problems and achievements in health of so-called socialist countries, these are frequently presented through rose-coloured spectacles, thereby hindering a realistic assessment of alternative policies for moving towards Health for All by the Year 2000, WHO's current organizing doctrine. This (and its constituent concept of primary health care) contains elements of ideological make-shift and contradiction, especially with regard to the ideas of 'political will' and 'community participation'. The paper ends with a discussion of the latter concept. In practice this may mean little more than co-option and contribution, or it may give people a genuine chance to influence what deeply affects them. It does not help to erase such fundamental differences by the ideological language of international compromise.