Health services as a defence against the consequences of poverty in industrialised societies

The purpose of this paper is to offer, as a basis for discussion, a review of the issues involved in a consideration of the role of helth services as a 'defence' against the consequences of poverty. First, some general questions are asked: It is true that industrialised nations have reached a stage of development where health care is irrelevant to health? Is the issue inequality in health, or more narrowly the particular problems of a minority, the 'poor'? Are the causes of disadvantage in health to be seen as behavioural or structural, and if health systems concern themselves with social-structural issues, is this medical imperialism or the proper exercise of responsibility? The role of health services is considered in relation to primary prevention, secondary prevention (or curative medicine) and tertiary prevention (or rehabilitative medicine). It is concluded that (though the impact of any form of universally-available health service must not be minimised) health systems in industrialised societies are not in general successful in mitigating or preventing the health problems of poverty. Some socio-medical policy programmes and some health-care delivery initiatives have, however, produced measurable effects. It is suggested that, while health systems can never wholly compensate for social inequalities in health, 'community' programmes may perhaps most effectively combine the structural and the individual approaches.