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399 Annals Am. Acad. Pol. & Soc. Sci. ix (1972)

handle is hein.cow/anamacp0399 and id is 1 raw text is: INTRODUCTION

The nation's health, even more than personal health, is a complex phenomenon
definable by a continuum of variables ranging from social integration through
political stability to economic progress, or, in a different and narrower focus,
according to criteria relating to social, physiological, and psychological states.
The health of persons, or personal health, according to the famous definition of
the World Health Organization, is a state of complete physical, mental, and
social well-being and not merely the absence of disease or infirmity. 1 The social
dimensions are explored by Parsons, according to whom the essence of health is
the individual's optimum ability to perform effectively those roles and tasks for
which he has been socialized. 2
Narrowing our focus to the absence of somatic and mental conditions impinging
on functional abilities, it is still obvious that health so defined is today rarely the
result of what is called health care or medical care. The narrowly defined
health status of the individual is determined by genetic factors, environmental
conditions, nutritional regimens, life styles, and chance. Some complexities of
genetic diseases are described in the paper by Stevenson and Howell, which also
makes clear that neither the health care system nor the political system yet deals
adequately with the range of questions raised by genetically related illnesses.
With the essential elimination or control, at least in our society, of the major
contagious and parasitic diseases, the current function of the medical care sector
is restorative and ameliorative. It is sickness care. Medical services are provided
to retard the progression and to alleviate the implications of chronic diseases, to
terminate successfully episodes of acute illness, and to attempt to ease the process
of dying. Medical care is designed to cure when it can, to manage when it cannot
cure, and to dignify when it can do neither. There is a consensus that the medical
care sector, while ever costing more, is not performing any of its functions well
for all those who could benefit by them, a nearly ubiquitous view that there is a
health care crisis. The multiplicity of proposals for the cure in terms of deliv-
ery, organization, financing, and control is evidence that dissatisfaction with the
performance of the medical care sector has reached the status of a politicized
social problem. As in other complex diseases, while there is agreement that
something is drastically wrong, there is no consensus on either the diagnosis or
the therapy. And the prognosis is pessimistic.
Of the large set of proximate causes of the malfunctioning of the medical care
sector-which in a more detailed analysis are seen as symptoms-we may identiy
the five salient ones:
1. Shortages in the availability of providers and resources-particularly in the
inner cities of large metropolitan areas and in the low population density sectors
of the country-as well as barriers to access to the available resources. This is
1. Constitution, in The First Ten Years of the World Health Organization (Geneva:
World Health Organization, 1958).
2. Talcott Parsons, Definitions of Health and Illness in the Light of American Values and
Social Structure, in E. G. Jaco, ed., Patients, Physicians and Illness (New York: Free Press,
1958), p. 176.
ix

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