Politics and health inequalities

摘要

Health inequality has always attracted the attention of people interested in social justice. But, at the same time, we have always shrunk from the inherently political nature of what it implies. Rudolph Virchow reminded us that "Medicine is politics and social medicine is politics writ large" and, more recently, Geoffrey Rose pointed out that as the determinants of health are social and economic, "medicine and politics cannot and should not be kept apart". But political activism does not fit easily with respectable academic research careers. How can the supposed objectivity of science come to terms.with the contrasting political implications of our explanations of health inequalities?Karl Popper argued that it was not the sources of theories that had to be unbiased, but the methods of testing them. Central to the advance of science were "crucial experiments" where competing theories made different predictions allowing one or other to be knocked out. But new theories are often surrounded by what seems to be conflicting evidence from the start: a strong theory advances partly by showing that what we took to be "the facts" can be reinterpreted.In statistical work on the social determinants of health, we constantly encounter results that are not what we would expect. Should we discard our theory or try to find out what is wrong with the data? This is not a decision that logic can make for us.