ABSTRACT
This chapter discusses the three issues of medicine: effectiveness, efficiency and social ideology. The practice of public health medicine within medicine confronts these issues as centrally important for improving the contribution of clinical medicine to the public’s health. Evaluation of medical treatments is both a scientific and a moral issue. Public health medicine thus poses evaluation questions that go to the heart of medicine’s self-image and, potentially, is a challenge to the power of medicine. The social and cultural standing of medicine presents a problem for the social understanding required to bring about a really effective health policy. The social ideology of medicine together with what Le Grand called the ‘ideology of inequality’ is massive barriers to a realist health policy. A social ideology of medicine is a powerful means through which positive attitudes and responses towards medicine perpetuate themselves.
